Untreated high blood pressure can cause blood vessel damage including narrowing of the arteries and aneurysm, and lead to many heart conditions, including coronary artery disease, heart failure, enlarged left heart and metabolic syndrome.  High blood pressure is the most prevalent and modifiable risk factor for cardiovascular disease and can affect adults in all age groups. Based on the American Heart Association’s 2025 Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults, the treatment goal for adults with hypertension is less than 130/80 mm Hg.

Non-communicable diseases (NCDs) are responsible for roughly three out of five deaths globally, and  approximately 73% of these deaths occur in low- or middle-income countries. CVD accounts for more of these deaths than other chronic health conditions such as diabetes, cancers and chronic respiratory illnesses.

“In this study, we analyzed existing data to assess if expanding use of NCD preventive healthcare services across 20 countries worldwide could reduce cardiovascular death. We found that expanding treatment of high blood pressure to more people prevented the most deaths, followed by more broad use of statin medications for high cholesterol and managing blood sugar in people with Type 1 or Type 2 diabetes,” said Scott Pilla, M.D., M.H.S., an associate professor of medicine at Johns Hopkins University School of Medicine in Baltimore.  “While there were substantial gaps in the use of preventive healthcare services for these conditions in all countries, lower-middle-income countries had large opportunities for improvement, with low rates of hypertension control and high cholesterol management and minimal use of cancer screening tests.”

What are the study’s key findings?

• The modeling analysis estimated that when preventive care services were increased across the 20 upper- and lower-middle income countries in the study, from current levels to match the levels in high-performing U.S. health systems—approximately 80% of eligible patients—the study found that hypertension control, treatment with statins when indicated, and glucose control could prevent 518,476; 340,682; and 309,520 annual cardiovascular deaths, respectively. Increasing colon cancer screening to 80% could prevent 206,767 colon cancer-related deaths each year.
• Improving blood pressure control prevented the greatest number of deaths out of any preventive service, especially in upper-middle-income countries (223,282 annual deaths) and lower-middle-income countries (223,655 annual deaths).
• The modeling estimates found that only about one in five adults with hypertension in the 20 studied countries had blood pressure controlled (lower than 140/90 mm Hg). Similarly, 16% of individuals with high cholesterol levels use statins; 39% with Type 1 or Type 2 diabetes had blood sugar below optimal levels; and 14%-26% underwent routinely indicated cancer screenings.
• Among cancer screening modalities, colon cancer screening prevented the most deaths, followed by cervical and breast cancer screening, respectively.

“This modeling analysis offers important information on the potential global impact of high blood pressure and, importantly, the opportunity to, with treatment, reduce the  number of deaths due to high blood pressure-related conditions. Previous research has confirmed that following the evidence-based recommendations in the latest guideline can reduce the risk of death from high blood pressure and also reduce the risk of other serious conditions, such as heart failure, stroke and dementia,” said Chair of the American Heart Association’s 2025 guideline writing committee Daniel W. Jones, M.D., FAHA . “Treatment of high blood pressure to goal leads to longer lives and also healthier lives. This study should inspire clinicians and patients to give more attention to appropriate management of high blood pressure using both lifestyle measures and medication.” Jones, who was not involved in this study, is also a past volunteer president of the American Heart Association (2007-2008) and is dean and professor emeritus of the University of Mississippi School of Medicine in Jackson, Mississippi.

What are the details, background, design and limitations of the study?

• The study modeled eligible populations across 20 countries with the highest numbers of deaths from noncommunicable diseases. Eligibility and treatment or screening targets for each preventive service were based on major clinical guidelines.
• Researchers applied statistical models to estimate the number of lives that could be saved globally each year if six evidence-based preventive services were increased: control of blood pressure; treatment with statins when indicated; glucose control in people with diabetes; as well as screening for colon, breast and cervical cancers.
• They reported outcomes overall and according to World Bank-defined categories of country-specific income. No lower income countries were among the 20 included countries.
• Age- and sex-specific data on the eligibility for and use of preventive services were ascertained from the Global Burden of Disease network, the NCD Risk Factor Collaboration, the WHO STEPwise Approach to NCD Risk Factor Surveillance and the WHO Cancer Screening databases.
• Achieving preventive care targets was defined according to major clinical guidelines: blood pressure below 140/90 mm Hg (the American Heart Association’s 2025 guideline for initiating blood pressure medication; note, of the guideline recommends treated blood pressure targets below 130/80 mm Hg); statin therapy according to the American Heart Association/American College of Cardiology’s 2026 dyslipidemia guideline criteria; hemoglobin A1c below 7.0%, per the American Diabetes Association’s guideline; and age- and sex-appropriate cancer screening intervals, as recommended by the U.S. Preventive Services Task Force.
• A limitation of the study is that some countries included in the analysis had limited data about use of preventive care services. In addition, the study does not offer specific strategies for how to improve use of and access to preventive healthcare services. The researchers suggest that future studies might explore such approaches to bridge the gaps identified.

Note: This abstract will be presented in an oral presentation at 10:15 a.m. ET, Sunday, October 11, 2026.

Co-authors, their disclosures and funding sources are listed in the abstract.

Statements and conclusions of studies that are presented at the American Heart Association’s scientific meetings are solely those of the study authors and do not necessarily reflect the Association’s policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. Abstracts presented at the Association’s scientific meetings are not peer-reviewed, rather, they are curated by independent review panels and are considered based on the potential to add to the diversity of scientific issues and views discussed at the meeting. The findings are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal.

The Association receives more than 85% of its revenue from sources other than corporations. These sources include contributions from individuals, foundations and estates, as well as investment earnings and revenue from the sale of our educational materials. Corporations (including pharmaceutical, device manufacturers and other companies) also make donations to the Association. The Association has strict policies to prevent any donations from influencing its science content. Overall financial information is available here.

Additional Resources:

• Multimedia, including a video interview with American Heart Association president, Daniel W. Jones, M.D., FAHA , is on right column of release link.
• The abstracts will be published at 10 am ET, Nov. 17, 2026, in the Hypertension Scientific Sessions 2026 Supplement of the Hypertension journal.
• American Heart Association news release: The lowdown on high blood pressure: what you need to know (May 2026)
• American Heart Association news release: Millions are unaware of heart risks that don’t start in the heart (Feb. 2026)
• American Heart Association news release: Heart disease, stroke deaths down, yet still kill more in U.S. than any other cause (Jan. 2026)
• American Heart Association health information: High Blood Pressure
• American Heart Association health information: How to Manage High Blood Pressure
• Follow American Heart Association news from the meeting on X @HeartNews, #Hypertension26.

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In the trial, 39 adults with prior GLP-1-induced weight loss were randomized to usual care, a digital wellness application, or medically tailored meals at the time of GLP-1 cessation, continuing for 4 months.

Surveys showed that diet quality, perceived health, adherence, and satisfaction did not differ significantly by group, though some estimates suggested possible trends favoring the wellness application. Relative to the control group, the other groups experienced less weight gain. Over 4 months, participants in the control group gained an estimated 10.75% body weight, compared with 3.60% in the wellness application group and 3.58% in the medically tailored meals group.

“People invest significant time and effort in improving their health and achieving weight loss,” said corresponding author Kelseanna Hollis-Hansen, PhD, MPH, of Tufts University Food is Medicine Institute. “We need evidence-based strategies to support them if and when they discontinue GLP-1 medication, so they can maintain those gains and continue building long-term health, vitality, and well-being.”

URL upon publication: https://onlinelibrary.wiley.com/doi/10.1002/osp4.70194

About the Journal
Obesity Science & Practice is an open access journal which offers prompt publication of high-quality original research related to all aspects of obesity and its comorbidities. The journal publishes papers of interest to researchers in academic, clinical, government and industry roles working to develop, test, and refine new medical, behavioral, dietary, pharmacologic and surgical approaches to treat obesity. The journal also publishes papers of interest to professionals engaged in the clinical management of obesity and its related comorbidities as well as individuals actively involved in the prevention of obesity at the local, regional, national and international level.

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In-process quality control using augmented reality smart glasses (FlexOprep®) reduced risk levels and improved traceability in chemotherapy compounding, according to Loélya Istace (Pharmacy Department, Vivalia Hospital, Arlon, Belgium). The trade-off was a longer preparation time.

Anticancer drugs have a narrow therapeutic index and high toxicity, so medication errors during compounding are a major threat to patient safety. Current quality control methods have important limitations. The FlexOprep glasses are smart glasses equipped with artificial intelligence. After a chemotherapy prescription has been validated by a pharmacist, the information is loaded into the FlexOprep system. The glasses are entirely hands-free and voice-controlled, and they display context-specific instructions in the operator’s field of view at each step of the preparation. They check the pharmaceutical products, expiry dates, the type of bag, pump and diluent, the volumes drawn and the secondary lines, and they alert the operator to errors. Every step is recorded in a report, which provides full traceability. Ms Istace compared the system to an aircraft’s black box.

FlexOprep glasses

This study used a prospective before-and-after design. A multidisciplinary team of 12 people from three hospitals carried out a failure mode and effects analysis (FMEA). They compared risk priority numbers before and after the glasses were introduced. Preparation times were measured for eight drugs, chosen to cover all types of preparation (syringes, bags, pumps and reconstitution). Usability was assessed with the French System Usability Scale (F-SUS), and user experience with the User Experience Questionnaire (UEQ).

The FMEA identified 24 potential failure modes, and half of them became less critical after implementation. The overall risk priority score fell by 40%, and by 67% for the 12 failure modes directly affected by the glasses. All high-risk failures were downgraded, and most moderate risks were reduced to low risk. The largest improvements were in error detection, for example selecting the wrong medicine or volume, and in failing to detect a preparation error before release. However, some new technology-related risks emerged.

Preparation time increased significantly for all eight drugs (p=0.008). The median increase was 86 seconds per preparation (+34%), ranging from 19.2% for paclitaxel to 54.7% for fluorouracil bags. The increase did not depend on the number of preparation steps; preparations that were initially quicker showed proportionally larger increases. Ms Istace noted that the extra time was probably overestimated, because it was measured immediately after the glasses were introduced, without an adaptation period. Usability was rated excellent, with a mean F-SUS score of 86.7/100. UEQ results were positive in every dimension, particularly novelty and stimulation.

The authors concluded that augmented reality-assisted in-process quality control is a significant advance in the safety and traceability of chemotherapy preparations. In particular, it eliminates the need for a second checker during the compounding process and it was well accepted by staff. Rigorous validation and long-term follow-up will be needed. Next steps include documenting new failure modes, carrying out an ergonomic analysis, improving the reading of syringes and secondary lines, and automating report validation. Ms Istace concluded with an aviation analogy: better to take off late than never arrive.

During the discussion Ms Istace confirmed that technicians are able to wear the glasses all day without complaining of visual problems. The costs are similar to those of a fixed video camera but FlexOprep has the advantage that the pharmacy technicians can move from one isolator/cabinet to another because, in this case, the camera is mobile i.e. attached to the technician.

Istace L, Leynen O, Denoël M, Roland I. Impact of augmented reality-assisted in-process quality control (FlexOprep®) on the safety and traceability of chemotherapy preparations. Short communication. GERPAC Congress 2026

Image: Loélya Istace

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People who already have glaucoma who are taking statins appear less likely to need stronger treatments like extra eye drops or surgery to keep it under control, the US study finds.

Glaucoma, a leading cause of irreversible blindness, is caused by permanent damage to the optic nerve.

Statins are prescribed to lower cholesterol levels but studies have indicated that they may also prevent or slow nerve cell death. Their potential role in preventing or slowing down glaucoma is poorly understood.

To strengthen the evidence base, researchers searched a large global database covering 165 million individuals.

They compared more than 210 000 people who had a record of statin use between August 2006 and August 2026 with a matched control group of 210 000 people who had no record of using statins. Individuals in both groups had to have a recorded ophthalmological follow up.

Statin use was associated with a 15% lower risk of developing open angle glaucoma, the researchers found.

At five years, there were 4771 new diagnoses of glaucoma in the statin group (2.3%) and 5491 in the control group (2.6%).

In a separate analysis, more than 30 000 individuals with glaucoma who were taking statins were compared with almost 250 000 individuals with glaucoma who were not taking statins.

Statins were linked to a lower risk of the individual progressing to need glaucoma surgery or other treatment.

At five years, statin use was associated with a 36% lower risk of incisional glaucoma surgery and a 55% reduced risk of minimally invasive glaucoma surgery (MIGS) – a keyhole procedure to lower the intraocular pressure in the eye.

Statins were also associated with a 60% lower risk of selective laser trabeculoplasty (SLT) – a procedure that lowers the pressure in the eye by using laser pulses. There was also a 12% reduced risk of eye drops to reduce the pressure in the eye linked to statin use.

After 10 years, statin use continued to be associated with a lower risk of incision glaucoma surgery, MIGS, SLT, and use of eye drops, the researchers found.

This is an observational study and as such, no firm conclusions can be drawn about cause and effect.

Another limitation of the study is that the researchers did not have access to individual patient data, including intraocular pressure measurements or surgical details

This means they were unable to determine whether surgery was performed due to increased disease severity or because the patient was not adhering to treatment.

Nevertheless, they say their findings add to the growing literature about the neuroprotective effect of statins. Prospective randomised trials are now needed to better understand the effects of statin use on glaucoma incidence and treatment, they add.

“Our findings suggest that statin usage is associated with both lower incidence of primary open-angle glaucoma as well as decreased treatment escalation, “the researchers say.

DOI – 10.1136/bjo-2026-330339

Method of Research – Observational study

Subject of Research – People

Article Title – Statin use is associated with lower risk of open-angle glaucoma incidence and treatment escalation

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Trastuzumab deruxtecan (Enhertu®) diluted in 5% glucose keeps its physicochemical, structural and functional characteristics for at least 28 days at 2–8°C when protected from light, according to Yara Bendiab (Pitié-Salpêtrière University Hospital, AP-HP, Paris). This is a major improvement on the 24 hours stated in the Summary of Product Characteristics (SmPC). At room temperature, however, glycation and oxidation gradually reduce the drug’s biological activity.

Trastuzumab deruxtecan (T-DXd) is a third-generation antibody-drug conjugate used in HER2-positive breast cancer. It consists of an anti-HER2 antibody linked to about eight molecules of deruxtecan. Its short post-dilution shelf-life prevents advance preparation and limits flexibility for outpatient and home care. It also leads to waste: the hospital’s losses on this drug came to more than €74,000 in 2024.

In this study, three batches of T-DXd at 1 mg/mL and 4 mg/mL were prepared in 5% glucose in multilayer polypropylene bags. The bags were stored for 28 days at 2–8°C or at 25°C. Forced degradation studies (heat, pH, light, agitation, oxidation and freeze–thaw cycles) were also carried out. The team used a wide range of complementary analytical methods covering colloidal stability, aggregation and fragmentation, hydrophobicity, glycosylation, charge variants and structural modifications. Biological activity was assessed by HER2 ELISA and Fc receptor affinity. They also checked the integrity of the drug–antibody linkage.

Under refrigeration, all the parameters remained essentially unchanged. The pH stayed at 5.4–5.5 and no visible particles appeared. Antibody concentrations varied by less than 5%, regardless of concentration, temperature or batch. There was no aggregation, fragmentation, change in glycosylation or loss of the drug payload. HER2-binding activity was 94% of the initial value after 28 days.

At 25°C, mass spectrometry detected glycation and oxidation of the antibody after one to two weeks. An increase in acidic variants followed from day 21. By day 28, HER2-binding activity had fallen to 78%.

The authors concluded that diluted T-DXd preparations can be stored for at least 28 days under refrigeration and protected from light. This would allow doses to be prepared in advance, with benefits for patients, hospitals and the environment. The bags should not be stored at room temperature for prolonged periods.

Juul C, Bendiab YM, Hindès E  et al. Glycation and oxidation: key determinants of the physicochemical behaviour of trastuzumab deruxtecan (Enhertu®) in a glucose infusion solution. Short communication. GERPAC Congress 2026

Image: Yara Bendiab

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Hospices Civils de Lyon (HCL) is now able to produce therapeutic bacteriophages in-house to GMP standards and has obtained authorisation to manufacture them as active substances, according to Camille Merienne (HCL Pharmacy department and FRIPHARM®, Lyon).

Antimicrobial resistance is a growing global threat and could lead to 10 million deaths annually by 2050. Bacteriophages are a promising alternative to antibiotics but phage therapy medicinal products (PTMPs) are ultra-personalised treatments. They must be matched to each patient’s bacterial strain and continually adapted as new strains emerge. Dr Merienne explained that this requires vertical integration within a single institution, covering phage discovery, selection, production, purification, formulation, diagnosis and treatment. At the same time, the products must meet the same quality, safety and efficacy requirements as other medicines.

The team developed injectable suspensions of bacteriophages against Staphylococcus aureus, working closely with clinicians and patients. The French National Reference Centre for staphylococci collected and characterised multidrug-resistant S. aureus strains, and the most active phages were selected. Genomic sequencing ensured that only non-temperate phages and non-pathogenic host strains were used, and these were stored in a biobank compliant with ISO 20387. Phages were amplified to 10¹⁰ plaque-forming units/mL and filtered. They were then purified by tangential flow filtration and formulated with a patented excipient system. Finally, they were aseptically filled into Type I glass vials in a grade A environment.

Twelve pilot batches of four different phages were produced. Quality control criteria were defined by risk analysis in line with the European Pharmacopoeia chapter on phage therapy (5.31). They covered efficacy (titre and genomic identification), the requirements for a sterile injectable suspension, and process-related impurities such as host cell proteins and DNA, endotoxins and residual reagents. In total, 1,700 quality control points were assessed, including release tests and a two-year ICH stability study. A toxicity and tolerance study was also carried out in rabbits.

Development of the formulation, production process and quality control took three years, and GMP qualification took a further two. A dedicated team was recruited: a PhD student/project manager, a quality engineer and a laboratory technician. Five audits (two internal and three external) led to 95 corrective and preventive actions. All processes now comply with EU GMP Part II, the European Pharmacopoeia and EMA requirements. The French medicines agency (ANSM) has authorised the FRIPHARM platform to manufacture active substances for hospital preparations.

The authors concluded that this achievement means phage therapy can be offered to patients and that biotherapies can be integrated into the hospital’s pharmaceutical preparations. Phase I/II clinical trials are planned. Phages against Escherichia coli, Pseudomonas aeruginosa and Klebsiella pneumoniae are being developed next.

Merienne C,Marchand C, Lapras B et al. Institutional hospital-based production of therapeutic bacteriophages. Short communication. GERPAC Congress 2026

Image: Camille Merienne

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The study, published Oct. 1 in JAMA, is among the first to document a surge in new prescriptions for the popular diabetes and weight-loss medications, such as Ozempic and Zepbound, among postpartum women in the United States. It is the first to identify which clinical groups — women with diabetes, gestational diabetes, obesity, or no documented diagnosis — are driving this growth.

Researchers examined private insurance claims data for just over 1 million births during a seven-year period. The share of new mothers starting a GLP-1 prescription within six months of giving birth increased from .08% in the first half of 2018 to 1.9% by the first quarter of 2025—a 24-fold increase.

Women with type 2 diabetes had the highest rate of prescriptions. Among this group, the share starting a GLP-1 prescription increased from 2.3% to 16.9% (or about 1 in 6) over the same period.

The share of those with gestational diabetes who started a GLP-1 prescription also rose substantially, from 0.4% in mid-2021 to 2.7% in first quarter of 2025. Gestational diabetes, which develops during pregnancy among women who previously did not have diabetes, affects about 5% to 9% of pregnancies and greatly increases the risk of developing type 2 diabetes.

Prescribing increased fastest in relative terms among those diagnosed as obese or overweight before pregnancy, from 0.4% in the second half of 2021 to 3.9% in the first quarter of 2025.

More recently, women with diagnosed obesity or overweight have represented a greater share of postpartum GLP-1 users. Since the second half of 2024, this group accounted for 40% of new prescriptions among postpartum women, followed by 21% who lacked a documented qualifying diagnosis before giving birth. Most who did not have a pre-pregnancy diagnosis did receive one—usually obesity or overweight—before starting a GLP-1.

Patients are advised to stop using GLP-1s during pregnancy, and most postpartum women who started a GLP-1 did so at least three months after giving birth.

“Postpartum is a critical window for addressing metabolic risk after pregnancy, and we’re seeing GLP-1 use explode in this population. Because evidence on GLP-1 exposure during breastfeeding remains limited, rising postpartum initiation warrants further study,” said lead author and Schaeffer scholar Sih-Ting Cai.

Despite differences in healthcare systems, the overall prescription start rate among new U.S. mothers was similar to the rate among postpartum women in Denmark, as reported in in a JAMA study last year. The new study does not include mothers enrolled in Medicaid, which covers about 40% of U.S. births.

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During the 2025/26 RSV season, the number of hospital admissions among infants aged 0 to 5 months fell by 75 per cent compared with the average of the previous three seasons. While admissions averaged 1,128 in those years, only 296 infants were admitted between October and April in the most recent season.

‘That’s more than 800 infants who avoided hospital admission over the winter. For these very young children, RSV can be particularly serious and may cause severe breathing difficulties. It is a major strain on both children and their families, so this is a remarkable development,’ says Prof Thea Kølsen Fischer, Clinical Professor at the Department of Public Health and co-author of the study.

The findings are consistent with experiences from countries including Belgium, Spain, the Netherlands, France and England, all of which have introduced RSV vaccination programmes. As well as potential health outcomes, the programme may ease the burden on health services at a crucial time of year.

‘I work in a hospital every day, and colleagues from paediatric departments across the country tell me that the RSV season often places enormous pressure on their services. This year, they have not seen the usual surge in admissions,’ says Prof Kølsen Fischer.

RSV follows a clear seasonal pattern in Denmark, with most hospital admissions occurring between October and March. For that reason, the vaccine is offered to women due to give birth during or shortly before this period. In the first season, 72 per cent of eligible pregnant women accepted the offer of vaccination.

‘It is encouraging that so many women chose to be vaccinated in the first season,’ says Prof Kølsen Fischer.

Despite the sharp decline in admissions, RSV is unlikely ever to disappear completely because it is both widespread and highly infectious. However, researchers believe it may be possible to reduce the burden of severe disease to a much lower level than in previous years.

‘I expect at least as many people to accept the vaccine next season, both because of these early results and because it is a very safe vaccine with very few side effects,’ Prof Kølsen Fischer said.

Older adults at increased risk, including people over 60 with conditions such as chronic obstructive pulmonary disease (COPD), can also receive financial support for vaccination in Denmark which researchers say will have a longer-term impact on the burden of disease.

‘If fewer older people become seriously ill, I believe we will move much closer to controlling a virus that has traditionally caused a large number of sick days and hospital admissions,’ she says.

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Obesity: a chronic, multifactorial disease

Despite classification by the World Health Organization as a chronic disease², obesity is still not consistently recognised as such in UK clinical practice, notes Ms Shahid. “It’s not as simple as eat less and move more,” she says. Genetics, epigenetics, social and cultural factors, environment, psychology and behaviour all contribute, meaning some people are more susceptible to weight gain than others.

Why weight loss is hard

Appetite and satiety are governed by three interacting brain systems: the mesolimbic system, which drives the hedonic “wanting and liking” of food; the hypothalamus, which regulates hunger, satiety and energy expenditure; and the prefrontal cortex, responsible for executive control and self-discipline. In a healthy weight, these pathways are balanced. In obesity, they become dysregulated: hunger hormone levels run higher than physiological need while satiety signalling is blunted, so patients eat more and register fullness later – a cycle that is not, Ms Shahid stresses, a failure of willpower.

GLP-1 (glucagon-like peptide-1) and GIP (glucose-dependent insulinotropic polypeptide) are naturally occurring gut hormones released after eating. They act on receptors in the brain, pancreas and adipose tissue. Weight-loss medicines mimic the actions of one or both of these hormones, reducing hunger and cravings, increasing satisfaction with smaller portions, improving insulin sensitivity and secretion, reducing glucagon secretion, and delaying gastric emptying so patients feel fuller for longer.

The clinical case for weight loss

Modest weight loss produces measurable benefit. A reduction of up to 5% of body weight begins to improve blood glucose, blood pressure, lung and kidney function, and outcomes in polycystic ovary syndrome and infertility. Beyond 5%, the risk of obesity-related cancers falls and joint pain and mobility improve; beyond 10–15%, cardiovascular mortality risk is significantly reduced. Patients with a BMI of 40 or above already have a life expectancy reduced by 8 to 10 years, so bringing BMI down also reduces the risk of diabetes, heart attack, stroke and cancer, says Ms Shahid.

Tirzepatide: indications and trial evidence

Tirzepatide is licensed for weight management, alongside diet and exercise, in adults with a BMI of 30 or above, or 27 or above with a weight-related comorbidity such as sleep apnoea, prediabetes, diabetes, hypertension or dyslipidaemia; it is also indicated for type 2 diabetes.

The SURMOUNT-1 trial randomised over 2,500 participants (average age 45, 67% female, mean 15 years living with obesity, baseline BMI around 38) to tirzepatide 5mg, 10mg or 15mg, or placebo. At week 72, placebo produced 2.4% weight loss, compared with 16% on 5mg, 21.4% on 10mg and 22.5% on 15mg – a difference of only one percentage point between the two highest doses. Waist circumference fell by almost 20cm on the 15mg dose, versus 3.4cm on placebo – “about eight belt holes,” says Ms Shahid. By week 20, patients on the 10mg and 15mg doses had already lost around 12.8% of body weight. DEXA scanning showed three times more total fat mass loss than lean mass loss, challenging the perception that tirzepatide causes disproportionate muscle loss – though some muscle loss accompanies any form of weight loss, and Ms Shahid counsels all patients on high-protein diets and strength training to help preserve muscle.

SURMOUNT-5, a head-to-head trial of tirzepatide 10mg/15mg against semaglutide 1.7mg/2.4mg in a similar population, found weight reduction of 21.6% with tirzepatide versus 15.4% with semaglutide at 72 weeks, and waist circumference reduction of 20cm versus 14.6cm. Notably, the results with higher dose semaglutide were comparable to those with tirzepatide 5mg – the second step of the titration schedule. Because most patients pay privately for treatment, Ms Shahid advises people to consider efficacy and time-to-target as well as cost. A longer titration period to reach equivalent results may not prove cheaper overall.

Individualising the dose

“It’s about slow and steady, not escalating every four weeks,” says Ms Shahid, who has no patients currently on the 15mg dose. Patients titrated too quickly to the maximum dose can find themselves with no further room to escalate once progress stalls. She increases the dose only when weight loss slows and appetite suppression wanes, provided side effects remain well controlled.

Safety and practical advice

Gastrointestinal effects – nausea, vomiting, constipation, diarrhoea, abdominal cramps – are common, particularly after starting or increasing the dose, but typically ease over time. Advice includes smaller, more frequent meals, mindful eating, 2–3 litres of daily fluid, and avoiding fatty, spicy or rich food, alcohol and fizzy drinks; a food diary can help identify triggers. Ms Shahid does not escalate the dose until side effects have settled.

Patients on insulin or sulfonylureas require dose adjustment to avoid hypoglycaemia, and prescribers should liaise with the clinician managing the patient’s diabetes. A history of pancreatitis warrants caution and patient education on warning signs such as severe abdominal pain radiating to the back; treatment should be discontinued if pancreatitis is suspected. Women of childbearing age should be advised to use barrier contraception for the first four weeks of treatment and at each dose escalation, since delayed gastric emptying may reduce oral contraceptive reliability.

Looking ahead

Ms Shahid is cautiously optimistic about retatrutide, a triple agonist currently in clinical trials, which may particularly benefit patients with a very high BMI or an inadequate response to existing agents. She warns strongly against unlicensed “black market” retatrutide already circulating: “please only ever use licensed medication.” She also welcomes the arrival of oral GLP-1 agonists, including newly launched oral formulations, which are bringing forward patients who had previously avoided treatment because of needle-phobia.

Ms Shahid also urges more careful language around obesity treatment, noting that terms like “skinny jabs” trivialise a prescription-only medicine for a chronic disease in a way clinicians would never apply to insulin or antihypertensives.

For Ms Shahid, the rewards of running a weight-management clinic lie well beyond the number on the scales. “You start peeling back all the layers,” she says, describing the improvements in confidence, relationships and comorbidities that follow sustained, individualised support.

References

1. NHS England. Health Survey for England, 2024. Jan 2026. https://digital.nhs.uk/data-and-information/publications/statistical/health-survey-for-england/2024
2. WHO Obesity and overweight. Dec 2025. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight

About Sehar Shahid

Sehar Shahid is the founder and superintendent pharmacist of 24HR Pharmacy, a UK online pharmacy. She is an independent prescriber.

Sehar serves as a Board Director for Scotland at the National Pharmacy Association (NPA), contributes to clinical training in obesity management, and mentors professionals through leadership and empowerment initiatives. She was recognised as Independent Prescriber of the Year at the Pharmacy Business Awards 2025.

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The changes should benefit kids’ health, but may be challenging for schools to implement, according to a Stanford Medicine study.

“It’s easy to say, ‘Let’s remove ultra-processed foods from school meals,’ but school districts will likely face many challenges in implementing this policy,” said the study’s senior author, Anisha Patel, MD, professor of pediatrics at Stanford Medicine.

The research team’s work, to be published Sept. 28 in Public Health Nutrition, identified the top challenges that school food service directors expect to face. Budget constraints, limited staff, difficulty with food procurement and inadequate kitchen infrastructure were their biggest concerns, the study reports.

Lawmakers will likely need to direct more funding to school food budgets to help put the new legislation into practice, said lead study author Andrea Pedroza-Tobias, PhD. She was an instructor in pediatrics at Stanford Medicine when the study was conducted and is now an assistant professor in residence at the University of California, Irvine. “It’s an investment in the future of these kids. For many California children, two of the three meals they eat per day come from their schools.”

Evaluating barriers

The new California statute, AB 1264, aka the Real Food, Healthy Kids Act, requires elimination of certain ultra-processed foods considered harmful to children’s health from school menus by July 1, 2035. Several other states are considering similar legislation to reduce kids’ risk for obesity and related health problems, and the latest version of the Dietary Guidelines for Americans encourages people to consume fewer ultra-processed foods. The U.S. Department of Health and Human Services also recently announced a $32.5 million initiative to help school districts test how to deliver healthier food to students.

Ultra-processed foods can be defined in several ways. Researchers typically use the Nova classification: industrially created food with additives that enhance the item’s taste or convenience. The new California law uses a more specific definition, with more details about which food additives are prohibited and the balance of nutrients required. Heat-and-serve foods, flavored yogurt, frozen pizza and breakfast cereals are common examples of ultra-processed foods that currently appear on school menus.

The Stanford Medicine team, along with their colleagues, interviewed food service directors from 20 school districts in California’s San Joaquin Valley, an agricultural region with many low-income families whose students depend on school meals. In the interviews, the researchers asked participants to rate how much of a barrier they anticipated certain factors would be in eliminating ultra-processed menu items. The research team also asked open-ended questions to allow detailed responses about various challenges.

Fiscal and logistical challenges

One major category of challenge was fiscal. Eliminating ultra-processed foods — which are cheap and easy to heat and serve with minimal kitchen equipment — will strain budgets, food service directors said.

In 2021, California began providing meals to all K-12 public school students for free, regardless of families’ incomes. Federal and state funding reimburse districts around $4.60 per lunch served, and with more kids eating the meals, schools can now offer more and better menu choices.

“That has been something positive for school districts: Universal school meals increased participation, which brought more money to districts’ food service programs,” Pedroza-Tobias said.

But less-processed items will increase costs, likely outpacing existing budgets, and will make some foods harder to procure.

Amanda Harvey, director of nutrition services for the Fresno Unified School District, who was a member of the community advisory board for study, encountered these problems when her team eliminated products containing food dye from their menus.

For instance, it was difficult for her school district to purchase pickles made without green dye No. 5. “They’re pricey for pickles, and it can be quite challenging for our vendor to get them,” Harvey said. “So sometimes we have a shortage of pickles because of this food dye.”

Measures that reduce food costs may become harder for schools to use, the researchers noted. For instance, districts can purchase inexpensive commodity foods through the U.S. Department of Agriculture — such as raw chicken — which they may send to a food processor in exchange for easier-to-serve items such as chicken nuggets. “While this practice helps schools that don’t have the kitchen infrastructure for anything but ready-to-eat foods,” Pedroza-Tobias said, “it can inadvertently increase the amount of ultra-processed food on the menu.”

Food service directors also identified challenges related to school staffing and infrastructure. Many schools employ part-time staff to heat and serve foods; these individuals may not be trained to cook similar foods from scratch. Scratch cooking also takes more time, and moving staff from part-time to full-time jobs would require larger budgets for staff salaries and benefits.

Many schools lack fully equipped kitchens, and retrofits are difficult. Harvey’s team explored whether they could make sandwiches from scratch in some of the elementary schools in her district that have kitchens designed only for heat-and-serve meals. The local health department denied the request because the kitchens did not meet permitting standards for scratch cooking, she said.

“They said, ‘In order to get these 50 schools permitted, you would need to add new sinks, drains and hoods,’” Harvey said. This would have cost millions of dollars, which would have had to come from district infrastructure funds, not the cafeteria budget, she added. The Fresno school district has a central kitchen facility equipped for scratch cooking, so Harvey’s team opted to make sandwiches there instead, but smaller school districts may lack that option.

Student preferences may also be a challenge, although some food service directors reported that students like certain fresh menu items. Harvey’s district works with chefs in developing scratch-made items they can add to their menus. Students also appreciate having more options on the menu, she said, adding that when her district began offering menu choices at elementary schools, “We definitely saw a huge decrease in parent and student complaints.”

Strategies for change

The research team also heard about how some districts have addressed these concerns. Some have bridged fiscal gaps with grant funding, although participants said that “if they get this funding for one year, and are not sure they’ll have the same money next year, they don’t feel like they can make sustainable changes,” Pedroza-Tobias said. Applying for grants also requires staff time, putting smaller districts with fewer support staff members at a disadvantage.

One district succeeded in making most of its food from scratch, in part because the food service director was a chef who also had a background in nutrition. “They also did a lot of engagement with families and students to increase the acceptance of scratch-cooked meals,” Pedroza-Tobias said. “For instance, they had a junior chef competition where students submitted a recipe, and they selected some of these recipes to cook in the school kitchen.”

The researchers hope their findings will help legislators and school districts navigate the challenges of serving healthier school meals, she said. Patel added, “Moving from ultra-processed food to scratch cooking requires an upfront investment, but healthier school meals can pay off in the long term by preventing health care costs associated with diseases such as obesity, Type 2 diabetes and cardiovascular disease.”

Researchers from the Dolores Huerta Foundation, Cultiva la Salud, and the Nutrition Policy Institute of the University of California Agriculture and Natural Resources contributed to the study.

The study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases (grant P30DK092924); the National Heart, Lung, and Blood Institute (grant K24HL169841); Stanford’s Maternal and Child Health Research Institute; the William and Nancy Thompson Family Foundation; and Stanford Impact Labs.

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A mechanical spring-driven pump for subcutaneous daratumumab improved ergonomics for nurses and reduced injection pain for patients, according to Wendy Johnson (Department of Pharmacy, AP-HP University Hospitals Paris-Seine-Saint-Denis, Avicenne site, Bobigny).

The Versapump system

Daratumumab is an anti-CD38 monoclonal antibody, mainly used to treat multiple myeloma. It is given as a subcutaneous injection over 3 to 5 minutes. Pushing the injection by hand against high resistance can cause musculoskeletal disorders in nurses, particularly thumb pain and postural discomfort. Organisational constraints meant that an electric syringe pump was not a feasible option in the haematology day hospital. The team therefore evaluated an alternative: the Versapump® (EMED Technologies). This is a calibrated mechanical spring pump with a passive flow regulator, connected to a 70 cm extension set with a 26G 9 mm needle.

A prospective study was carried out over one month. Nurses and patients completed questionnaires, and only patients who had previously received at least one manual injection were included. The evaluation covered ergonomics for nurses, administration time and patient comfort. The economic impact of the device was also assessed.

In total, 33 administrations by five of the six nurses dedicated to this activity were analysed. All the nurses were satisfied with the ergonomics of the device, and none reported thumb pain or postural discomfort during use. The majority of patients also reported less pain during injection. The mean administration time was 4.84 ± 0.50 minutes (range 4.3–6.4 minutes). The residual volume was 0.28 mL, or 1.87% of the 15 mL total, which was considered negligible. The device does add cost. For 2,000 administrations a year, the additional cost would be about €4,000 with a subcutaneous microperfuser set, or €10,000 with a hypodermic needle.

The authors noted some limitations. Flow rate control is less precise than with an electric syringe pump, and there is no passive needle safety system during needle withdrawal. However, the mechanical pump has practical advantages: it is quicker to set up than an electric syringe pump, administration time is short and it needs no power supply. They concluded that the ergonomic benefits for nurses and the organisational gains may offset the additional cost.

Johnson W, Laruelle C, Abomo Ngoo A et al. Evaluation of a new subcutaneous daratumumab administration device. Short communication. GERPAC Congress 2026

Image: Wendy Johnson

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Obesity, a chronic progressive disease, is exacerbated by oestrogen deficiency during menopause. Orforglipron, an oral small-molecule, non-peptide GLP-1 receptor agonist, was associated with significant body weight (BW) reductions in ATTAIN-1 and -2 studies, one of which looked at people living with overweight or obesity but not diabetes (ATTAIN-1) and the other with both conditions (ATTAIN-2). This additional analysis evaluates orforglipron‘s effect on BW in women by menopausal stage.

Female participants with obesity (BMI ≥30 kg/m²) or overweight (BMI ≥27 kg/m²) with at least one weight-related medical condition in ATTAIN-1 and -2 were analysed by menopausal status: pre-, peri-, or post-menopause, with the number of women in each category receiving orforglipron or placebo ranging from 142 to 225. BW, waist circumference (WC), waist-to-height ratio changes and the proportion achieving BW reduction thresholds (≥5%, ≥10%, ≥15%, ≥20%) vs placebo (PBO) were assessed at 72 weeks.

For women given orforglipron, significant and similar reductions in body weight up to 14% were experienced for pre-menopausal, peri-menopausal and post-menopausal women in ATTAIN-1, and in ATTAIN-2. (see results table full abstract)

Significant reductions in waist circumference of up to 12.5 cm were observed across subgroups with orforglipron for both studies. With orforglipron, up to 83% experienced at least 5% body weight reduction vs 30% with placebo. More orforglipron-treated participants experienced a shift to lower waist-to-height ratio categories than placebo.

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