Conservative approach to unexplained unintentional weight loss evaluation needed

• A new study examining the evaluation of unintentional weight loss (UWL) calls into question the widespread use of routine diagnostic testing when weight loss is unexplained, and underscores the need for a more conservative approach.
• Until this study, there was a lack of evidence-based guidance on how to best manage UWL.
• This study finds that serious conditions as causes of unexplained unintentional weight loss, including cancer, are uncommon.

CLEVELAND - Researchers at University Hospitals Cleveland Medical Center have completed a study aimed at improving how physicians evaluate unintentional weight loss, a common but challenging clinical problem, particularly among older adults.

The research was completed by the UH ADVANCE (Advancing Diagnosis through Validated Analytics and Novel Collaborations for Excellence) Center, a diagnostic error center of excellence funded by the Agency for Healthcare Research and Quality (AHRQ).

The UH ADVANCE Center found that diagnostic abnormalities were no more likely to occur among adults with unintentional weight loss than among comparison patients. In the vast majority of cases, the weight loss was not linked to a serious underlying condition. Researchers found the overall rate of cancer among patients with unintentional weight loss to be .7%.

Unintentional weight loss (UWL) frequently triggers extensive diagnostic evaluations, as physicians seek to rule out serious underlying causes. Researchers found that unintentional weight loss remains under-recognized in primary care settings, consistent with previous findings. In only 38% of cases UWL was recognized by physicians. When it is identified, physicians often respond with extensive testing. The study used electronic health record data to identify more than 3,000 patients with unintentional weight loss. Common diagnostic tests and procedures were compared among patients with recognized UWL and patients without UWL.  

The study showed none of the tests were more likely to be abnormal in patients with recognized UWL compared with patients without UWL. Based on this surprising finding, with a stakeholder panel, the UH ADVANCE Center developed a set of conservative recommendations for diagnostic evaluation of  UWL. While careful inquiry into causes of weight loss such as depression, lack of access to food, and chronic diarrhea is recommended, routine laboratory and other testing when such findings aren’t present is not recommended.

“These findings are striking,” said first author Goutham Rao, MD, Chief Clinician Experience Officer, University Hospitals. “They challenge long-standing assumptions and highlight the need for a more measured, evidence-based approach when we can’t find an obvious cause of weight loss. Our results can help clinicians better balance thorough evaluation and avoid unnecessary tests and procedures.”

Rao and his team recommend asking all patients who have lost weight the simple question, “I see you’ve lost X pounds since I last saw you. Can you tell me more about that?” That simple question is first likely to reveal whether the weight loss is intentional or point to another cause. If no obvious cause is present, Rao and his team recommend weekly self-weighing to monitor weight, rather than extensive testing. “Most patients who lose weight unintentionally gain it back within a year,” Rao noted.

In the future, researchers hope to see this recommendation incorporated into clinical decision support in electronic health records systems to raise awareness of UWL to both caregivers and patients.

“Despite how common unintentional weight loss is, there has historically been little evidence-based guidance to help clinicians determine the most appropriate evaluation,” said Rao. “Our goal is to provide physicians with data-driven insights into how often serious abnormalities are actually found and how best to approach care for these patients.”

The study began in 2022 and concluded in 2025 with the goal of providing physicians guidance on how to manage patients who are losing weight without trying. This study adds new evidence to guide caregivers in managing unintentional weight loss, with the potential to improve patient experience, reduce unnecessary testing, and support a more accurate and efficient diagnosis.

High BMI could increase dementia risk, study finds

 

High body mass index (BMI) could cause a higher risk of vascular-related dementia (a combination of vascular and unspecified dementia), according to new research from the University of Bristol and University Hospital of Copenhagen (Rigshospitalet and Herlev-Gentofte hospital). The researchers found that the effect of high BMI on dementia mainly works through high blood pressure.

 

The study published in The Journal of Clinical Endocrinology & Metabolism today [22 January] has shown that many dementia cases could be prevented if high BMI and high blood pressure is treated or prevented.

 

Previous observational studies have already found a link between midlife obesity and high risk of dementia, including vascular dementia. However, those studies did not uncover whether the obesity causes an increase in dementia risk or whether there is some other factor involved affecting both obesity and dementia risk.

 

The new study analysed population health data from Denmark, the UK and around the world using a powerful approach called Mendelian Randomisation. This statistical, computational technique looks at genetics and health data to see health patterns across large populations.

 

The researchers found that high BMI does increase the risk of vascular-related dementia. They also found that high blood pressure is the main factor in this association, pointing to the potential of treating high blood pressure to reduce dementia risk.

 

First author Dr Liv Tybjærg Nordestgaard, who initiated the project in Copenhagen and extended the work while at the University of Bristol, and who is now at the Department of Clinical Biochemistry at Copenhagen University Hospital -Bispebjerg and Frederiksberg, said: “Dementia is a devastating disease that currently affects 50 million individuals worldwide. Unfortunately, treatment and prevention options are scarce. Our study highlights the potential for reducing vascular-related dementia risk by addressing high BMI and/or high blood pressure in the population.”

 

Professor Ruth Frikke-Schmidt from the Department of Clinical Biochemistry at Copenhagen University Hospital - Rigshospitalet, and senior author, added: “Weight-loss medication has recently been tested for halting cognitive decline in early phases of Alzheimer’s disease, but with no beneficial effect. It remains, however, to be tested whether weight-loss medication initiated before the appearance of cognitive symptoms may be protective against dementia. Our study supports that early weight-loss interventions could prevent dementia, and especially vascular-related dementia.”

Treating cancer with medication before surgery continues to increase

 

Key Takeaways

• New report shows growing use of medications, such as chemotherapy, immunotherapy, and hormone therapy, given before surgery to treat many types of cancer, potentially making surgery less invasive and helping clinicians assess how a patient’s cancer responds to medication to guide the most effective treatment options.
• The report also provides in-depth data on esophageal, melanoma, and prostate cancers, including the median age at diagnosis and the most common surgery performed for each cancer.
• Researchers call for more attention to esophageal cancer, which lacks effective screening options and is diagnosed at an advanced stage in roughly half of patients.

CHICAGO — The second annual report from the National Cancer Database (NCDB) of the American College of Surgeons (ACS) documents a substantial rise in medication treatments, such as chemotherapy, immunotherapy, and hormone therapy, used before surgery to treat many cancers, often allowing less invasive surgery and helping clinicians assess how a patient’s cancer responds to medication to guide the most effective treatment options.

The report, published this week in the Journal of the American College of Surgeons (JACS), shows the most notable increases in neoadjuvant systemic therapy, which involves treatments that travel throughout the bloodstream and are given before surgery, for pancreatic, gynecologic, and abdominal lining cancers.

A comprehensive cancer database jointly run by the ACS and the American Cancer Society, the NCDB collects data on nearly 75% of cancer cases across the United States and includes metrics not often found in other cancer databases, such as tumor biology and length of hospital stay.

The report summarizes data from more than 22 million cancer cases diagnosed at 1,250 ACS Commission on Cancer (CoC) hospitals from 2004 to 2022, the most recent years for which complete data is available. It also describes in-depth data on esophageal, melanoma, and prostate cancers.

“The NCDB report includes clinically relevant data intended to inform not only researchers but also the public on recent observations of cancer involving the latest treatment, surgical options, and cancer outcomes,” said Ronald J. Weigel, MD, PhD, MBA, FACS, medical director of ACS Cancer Programs, and co-author of the JACS study. “As care at CoC-accredited facilities continues to advance, our hope is that this report reflects the vastly changing clinical landscape of cancer treatments using the latest evidence-based treatments.”

Big Picture Cancer Observations

Use of neoadjuvant systemic therapy increased notably for certain cancers. The researchers found that from 2010 to 2022, the use of neoadjuvant systemic therapy for gynecologic cancers rose nearly fivefold, from 7% to 34%. Substantial increases in neoadjuvant systemic therapy were also seen for pancreatic cancer, which more than tripled (12% to 40%), and for rarer cancers (peritoneum, omentum, and mesentery) that affect the abdominal lining and tissue, which nearly doubled (23% to 47%).

“Historically, when we thought about treating solid tumors, the first expected treatment was to have surgery to remove the tumor. Now, we are seeing treatment more frequently with targeted medication before surgery,” said Judy C. Boughey, MD, FACS, senior author of the JACS study, chair of the ACS Cancer Research Program, and chair of the Division of Breast and Melanoma Surgical Oncology at Mayo Clinic in Rochester, Minnesota.

Dr. Boughey noted the main advantage of neoadjuvant systemic therapy is twofold: first, it shrinks the tumor, ideally allowing for less invasive surgery; and second, it allows clinicians to better understand the tumor’s response to systemic treatment, which can help clinicians determine the most effective treatment for a patient.

“If a patient’s tumor responds to systemic therapy, they generally will do well with treatment; if that doesn’t happen, it tells the clinical team that they need to think about different therapy,” she said.

In-Depth Data on Three Cancers

The report also examined three cancers in depth: prostate cancer, a common (high-volume) cancer; esophageal cancer, a less common (low-volume) cancer; and melanoma, selected as a special interest cancer.

Prostate Cancer

Patients with prostate cancer, the most common cancer diagnosed in men, are increasingly being treated with non-surgical options, especially for patients with Stage 1 prostate cancer, according to the report. In 2022, roughly 60% of patients with prostate cancer were treated with methods other than surgery, a rise from 54% in 2018. Of patients who had surgery, removal of the prostate gland (prostatectomy) was the most common surgery, occurring in 85% of patients who had surgery.

Risk factors for dying from prostate cancer are also described in the report. Men who had a prostate-specific antigen (PSA) level over 20 at the time of diagnosis, as well as a higher cancer stage and grade of tumor, were more likely to die from the disease.

Esophageal Cancer

The number of patients with esophageal cancer who received immunotherapy rose sharply, increasing from 8% to 30% between 2018 and 2022. While the use of immunotherapy to treat esophageal cancer is growing, the disease is often detected at an advanced stage. About half of patients already have stage 4 disease at the time of their diagnosis.

In the JACS study, the authors call for an effective, widely used screening method to detect esophageal cancer earlier in more patients.

“If patients with esophageal cancer are diagnosed at less advanced stages, we theorize that more patients could be treated with surgery or other less invasive treatment options,” said Elizabeth B. Habermann, PhD, MPH, chair of the ACS Cancer Data Modeling Pillar, professor of health services research at Mayo Clinic in Rochester, Minnesota, and first author of the JACS study.

Melanoma

Melanoma, a skin cancer that can be deadly if not detected early, most often affected the torso (30%) or the upper limb and shoulder region (25%). Patients with scalp and neck melanomas had the lowest overall survival rates among all invasive melanomas. Ulceration, which occurs when the top layer of the skin involved by melanoma breaks down, was also associated with poorer survival, according to the report.

Future reports will focus on three other cancers to provide the public and researchers with unique data points not often included in other cancer reports, the authors added.

Co-authors of the JACS study are Courtney N. Day, MS; Bryan E. Palis, MA; Daniel Boffa, MD, FACS; Tina J. Hieken, MD, FACS; and Shaheen Alanee, MD, MBA, MPH, FACS.

This study is published as an article in press on the JACS website. 

Citation: Habermann E, Day C, Palis B, et al. National Cancer Statistics: American College of Surgeons Cancer Programs Annual Report from 2022 Participant User File. Journal of the American College of Surgeons, 2026. DOI: 10.1097/XCS.0000000000001747

Long-term physical inactivity linked to higher stress in midlife

Prolonged insufficient physical activity in adulthood increases the body’s stress burden, according to a large longitudinal study based on the Northern Finland Birth Cohort 1966. By contrast, engaging in physical activity in line with recommended guidelines appears to protect the body from harmful stress.

The health benefits of physical activity are well established, but the relationship between long-term physical activity and cumulative stress in the body has been studied less extensively.

A study conducted in collaboration between the University of Oulu and the Oulu Deaconess Institute Foundation sr. shows that exercise habits at different stages of adulthood influence how much long-term stress burden has accumulated in the body by midlife.

The study followed more than 3,300 individuals from the Northern Finland Birth Cohort 1966 from the age of 31 to 46. Participants’ leisure-time physical activity was examined in relation to the World Health Organization’s (WHO) physical activity recommendations. In addition, so-called allostatic load was measured, describing the strain imposed on the body by long-term stress.

According to the results, individuals who did not meet the health-enhancing physical activity recommendations during the follow-up period had a higher stress burden in midlife than those who were physically active in line with the recommendations. A decline in physical activity during adulthood was also associated with increased stress burden.

By contrast, individuals who increased their level of physical activity during adulthood did not differ in terms of stress burden from those who had remained physically active.

“The results suggest that the importance of physical activity is not limited to individual life stages; rather, regular exercise throughout adulthood may protect the body from the harmful effects of long-term stress,” says Doctoral Researcher Maija Korpisaari.

In the study, stress burden was assessed using both broader and narrower combinations of biological measures. The results were largely consistent regardless of the indicator used, strengthening the reliability of the findings.

Physical activity as part of stress management

The study provides new evidence that physical activity may be a key factor in preventing the long-term effects of stress.

“In terms of stress burden, both the amount of physical activity in youth and in adulthood are important. Regular physical activity in adulthood appears to help the body cope with stress even into midlife,” Korpisaari says.

According to the researchers, further longitudinal studies are needed to more precisely assess the use of different stress indicators and to understand how physical activity affects the body’s stress systems at different stages of the life course.

The results of the study have been published in the scientific journal Psychoneuroendocrinology. Association of longitudinal changes in physical activity with allostatic load in midlife.

https://www.oulu.fi/en/news/long-term-physical-inactivity-linked-higher-stress-burden-midlife

Two days of oatmeal reduce cholesterol level

 

A short-term oat-based diet appears to be surprisingly effective at reducing the cholesterol level. This is indicated by a trial by the University of Bonn, which has now been published in the journal Nature Communications. The participants suffered from a metabolic syndrome – a combination of high body weight, high blood pressure, and elevated blood glucose and blood lipid levels. They consumed a calorie-reduced diet, consisting almost exclusively of oatmeal, for two days. Their cholesterol levels then improved significantly compared to a control group. Even after six weeks, this effect remained stable. The diet apparently influenced the composition of microorganisms in the gut. The metabolic products, produced by the microbiome, appear to contribute significantly to the positive effects of oats.

The fact that oats have a beneficial effect on the metabolism is nothing new. German medic Carl von Noorden treated patients with diabetes with the cereal at the beginning of the 20th century – with remarkable success. “Today, effective medications are available to treat patients with diabetes,” explains Marie-Christine Simon, junior professor at the Institute of Nutritional and Food Science at the University of Bonn. “As a result, this method has been almost completely overlooked in recent decades.”

Although the test subjects in the current trial were not diabetic, they suffered from a metabolic syndrome associated with an increased risk of diabetes. The characteristics include excess body weight, high blood pressure, an elevated blood sugar level, and lipid metabolism disorders. “We wanted to know how a special oat-based diet affects patients,” explains Simon, who is also a member of the Transdisciplinary Research Areas “Life & Health” and „Sustainable Futures“ at the University of Bonn.

300 grams of oatmeal per day

The participants were asked to exclusively eat oatmeal, which they had previously boiled in water, three times a day. They were only allowed to add some fruit or vegetables to their meals. A total of 32 women and men completed this oat-based diet. They ate 300 grams of oatmeal on each of the two days and only consumed around half of their normal calories. A control group was also put on a calorie-reduced diet, although this did not consist of oats.

Both groups benefited from the change in diet. However, the effect was much more pronounced for the participants who followed the oat-based diet. “The level of particularly harmful LDL cholesterol fell by 10 percent for them – that is a substantial reduction, although not entirely comparable to the effect of modern medications,” stresses Simon. “They also lost two kilos in weight on average and their blood pressure fell slightly.”

The effect on LDL cholesterol, in particular, is likely to be relevant to health. If the blood contains too much of this, it is deposited in the vessel walls. These deposits, known as plaques, narrow the blood vessels. In addition, the deposits can rupture, for instance due to an increase in blood pressure following physical exertion, anger, or stress. As a result, a blood clot can form at the affected site, completely blocking the blood vessel. Alternatively, parts of the plaque can be washed away by the blood and cause a heart attack or stroke.

Oats promote the growth of “healthy” intestinal bacteria

But how does oatmeal exert its beneficial effect? “We were able to identify that the consumption of oatmeal increased the number of certain bacteria in the gut,” explains Simon’s colleague Linda Klümpen, the lead author of the trial. The microbiome has increasingly been the focus of research in recent decades. After all, it is now known that intestinal bacteria play a decisive role in metabolizing food. They also release the metabolic by-products that they create into their environment. They supply, among other things, the cells of the gut with energy, enabling them to better perform their tasks.

In addition, the microbes send some of their products around the body in the blood stream, where they can have various effects. “For instance, we were able to show that intestinal bacteria produce phenolic compounds by breaking down the oats,” says Klümpen. “It has already been shown in animal studies that one of them, ferulic acid, has a positive effect on the cholesterol metabolism. This also appears to be the case for some of the other bacterial metabolic products.” At the same time, other microorganisms “dispose of” the amino acid histidine. The body otherwise turns this into a molecule that is suspected of promoting insulin resistance. This insensitivity to insulin is a key feature of diabetes mellitus.

A large amount of oats for two days better than a small amount for six weeks

The positive effects of the oat-based diet tended to still be evident six weeks later. “A short-term oat-based diet at regular intervals could be a well-tolerated way to keep the cholesterol level within the normal range and prevent diabetes,” says Junior Professor Simon. However, in the current study, the cereal above all exerted its effect at a high concentration and in conjunction with a calorie reduction: A six-week diet, in which the participants consumed 80 grams of oats per day, without any other restrictions, achieved small effects. “As a next step, it can now be clarified whether an intensive oat-based diet repeated every six weeks actually has a permanently preventative effect,” continues Simon.

Test method:

A total of 68 participants took part in the trial. For the two-day short-term oat-based diet, all 17 participants on the oat-based diet and 15 participants on the control diet successfully completed the study phase. Two participants in the control group withdrew for personal reasons. For the six-week long-term oat-based intervention, 17 participants in the study group and the same number in the control group took part until the end. The sample size of 17 participants per group was calculated by the researchers on the basis of data from an earlier interventional trial.

Both the two-day intensive diet and the six-week trial with a moderate dose of oats were randomized controlled trials. In these “RCTs,” the test subjects are divided into two groups at random (i.e. randomized). One of them receives the potential active ingredient – in this case the oats –, but the other (the control group) does not. Ideally, the test subjects are “blind”: They do not know to which group they belong. This rules out any placebo effects.

In nutritional experiments, blinding is often not possible – those involved ultimately generally know what they are eating. This was also the case in these studies. However, the evaluation of the blood and stool samples was indeed “blind”: The researchers in charge of this were not informed whether the material had been taken from members of the test group or the control group. The same also applied to the blood pressure and weight measurements. This ruled out the possibility of the scientists’ expectations falsifying the results.

Blood and stool samples were taken before the participants made any changes to their diet. Their blood pressure, weight, height, waist size, and body fat were also measured. A second examination took place immediately after the two-day oat-based diet, followed by three others after two, four, and six weeks. The same analysis were conducted on these four visits as during the initial examination and further blood and stool samples were collected. The researchers took the same approach during the second nutritional study, in which the subjects consumed 80 grams of oatmeal a day for six weeks.

The blood samples were examined in the lab for their LDL cholesterol content, among other things. The researchers also measured the concentration of a key molecule, dihydroferulic acid. This phenolic compound is presumably formed by certain intestinal bacteria, which are known to have a health-promoting effect.

By examining the stool samples, the researchers were able to confirm this hypothesis. They isolated what is known as 16S RNA from the samples. This is a molecule that exclusively occurs in bacteria, but differs somewhat between different species. A 16S RNA molecule can thus be used to identify the bacterium from which it originates, just like a fingerprint. The researchers also analyzed which metabolic products were present in the stool.

We need to listen to the school children who can tell us what their diagnosed ADHD feels like

 Some people claim that ADHD is a modern invention and that too many people are being diagnosed with it. Others believe the disorder is real, with major consequences for those who have it. Norwegian University of Science and Technology (NTNU) professor and school researcher Marit Uthus is certain of at least one thing:

“We need to listen to the school children who can tell us what their diagnosed ADHD feels like, both physically and mentally. After all, they are the ones with first-hand experience. If they are given the chance to speak, the rest of us can better understand what they need in order to learn and participate in school on equal terms with everyone else,” said Uthus.

Autonomy in learning

Along with psychologist and researcher Audhild Løhre, Uthus has recently conducted an interview study focusing on two school children: ‘Sofie’ and ‘Benjamin’.

Both students have ADHD. The researchers followed the pupils and their teachers over the course of one school year during which their school introduced a new model for adapted education. Both pupils describe how they experienced gaining an entirely new sense of autonomy. One day a week, they are free to choose what they want to learn and to organize their schoolwork as they think best.

The study is small, but the researchers believe it introduces important and genuine experiences directly into the wider discussion about ADHD and inclusion in Norwegian schools, Uthus said.

An extra challenging form of learning

Because ‘Sofie’ and ‘Benjamin’ have inattentive ADHD, autonomous or self-regulated learning can be especially challenging. This type of ADHD triggers precisely those brain processes that are taxing for people with the diagnosis. This includes receiving and processing internal and external stimuli, and maintaining focus and self-regulation.

“Self-determination in learning means acting in accordance with oneself – or one’s own will. And when you become inattentive in your learning – when your thoughts slip beyond your own control – things don’t work. This is precisely where the challenge of self-determined learning lies for these pupils,” explained Uthus.

A double-edged sword

The school researcher describes their situation as a double-edged sword, because like everyone else, both ‘Sofie’ and ‘Benjamin’ like to make their own decisions.

Despite the challenges they face, they are motivated by their teacher’s trust and the opportunity to act autonomously in their own learning one day a week.

Thoughts that end up in the wrong place

Sofie describes her experience with ADHD like this:  “(...) it is as if my thoughts wander around in my head and end up in the wrong place. They then start to get all jumbled up in the very place where I should be concentrating. “(..) Once I’ve lost concentration, it’s like I’m in my own world.”

At the same time, the 11-year-old says, “When I get to decide for myself, I feel happy!”

She likes being able to decide what works best for her, such as choosing whether to tackle the hardest or the easiest schoolwork first.

“I want to decide for myself what to do, and it’s nice to be able to do that,” Sofie. said

Lose concentration – find motivation

Everything happens in collaboration with the teacher, but the pupils take the leading role. The starting point is that we all have an innate need to make our own decisions and influence what happens in our lives. When we experience tasks as meaningful and are able to act according to our own wishes and interests, that increases both motivation to learn and effort.

“So, even though ‘Sofie’ experiences her concentration slipping away, she manages to find new energy to keep thinking. In doing so, she compensates for what she loses. She replaces it with motivation to complete a task even when she is tired, finds it difficult or thinks it is boring. She is motivated by the good feeling of completing what she started,” Uthus said.

Harnessing the power of self-determination

Uthus believes that this type of real-life experience brings important new insights and meaningful depth to theories in educational research. If we view self-determination as a power we all have and can use to make learning more enjoyable, we can open up new opportunities for this group of pupils.

The study ‘Students with inattention and their experiences of autonomy in learning activities: an interview study with two students and their teachers’ was recently published in Frontiers in Psychology.

Uthus says the study focuses specifically on a few individuals’ experiences, and one that is worth exploring further.

Children with ADHD struggle at school

Uthus has spent many years studying inclusion in schools. This autumn, a different study from OsloMet found that only about half of children with ADHD thrive at school. Pupils who spend more than half of their school day being taught outside of their regular classroom community particularly tend to struggle.

“I think this is linked to the fact that school is an increasingly pressured environment to grow up in. Adaptation and support provided by teachers regarding pupils’ self-determination is crucial in all of this. Research suggests that these pupils are not receiving the support they need – specifically the support that takes place within the learning community of the classroom,” said Uthus.

ADHD does not mean learning challenges

She emphasizes that these are children with the same abilities and resources as everyone else. They are capable of achieving anything.

“ADHD is not a challenge associated with learning – but rather a challenge associated with attention. Being taken out of the classroom, because there is a lack of support in the classroom, feels like an unfair punishment. I believe it is important to stress that this is not necessarily due to poor teaching, but rather the lack of resources in today’s schools. We could go on endlessly discussing whether too many children are being diagnosed with ADHD, and what the reasons for this might be.  The point is that this debate leads nowhere for the individuals who need help,” explained Uthus.

Missing the point

Uthus believes that the debate around ADHD sometimes goes off track, with arguments over whether the diagnosis is real or socially constructed. She feels we pay too little attention to the experiences of the children and young people actually living with the diagnosis, and that there should be greater focus on how their learning environments are structured.

“Children and young people spend a lot of their waking hours at school. Their time there is a major determinant in how they will fare later on in life: in their future careers, in being part of society and in gaining a better quality of life – and this is why adaptation is so important. It is about engaging with pupils more effectively and getting to know them. Letting them experience that they are good enough as they are and that they are appreciated for all their differences,” said Uthus.

Brains work differently

“We could go on endlessly discussing whether too many children are being diagnosed with ADHD, and what the reasons for this might be.  The point is that this debate leads nowhere for the individuals who need help. If we instead focus on their experiences, it becomes less important whether ADHD is a real diagnosis or not. It is about inequality. We all have brains that work differently, and each of us falls somewhere along that spectrum,” concluded Uthus.

Reference:
Marit Uthus, Audhild Løhre: ‘Students with inattention and their experiences of autonomy in learning activities: an interview study with two students and their teachers’. DOI 10.3389/fpsyg.2025.1624279

---

Evidence-based lifestyle interventions endorsed as treatments for major depressive disorder

 

The American College of Lifestyle Medicine (ACLM) has published a new expert consensus statement outlining the important role of lifestyle interventions in the treatment and prevention of major depressive disorder (MDD), one of the most common mental health conditions worldwide. The statement was published in the American Journal of Lifestyle Medicine.

“Lifestyle Interventions for Major Depressive Disorder (MDD): An Expert Consensus Statement from the American College of Lifestyle Medicine,” synthesizes agreement from 12 experts in the fields of psychiatry, primary care, cardiology, behavioral health, obstetrics and lifestyle medicine. The panel reviewed extensive evidence and reached consensus on 71 statements addressing assessment, diagnosis, treatment, and long-term management of MDD in adults.

The consensus statement affirms that lifestyle interventions—optimal nutrition, physical activity, restorative sleep, stress management, connectedness, and avoidance of risky substances—are integral components of MDD care. Experts agreed that physical activity can be used as a primary therapy for adults with mild MDD and that lifestyle interventions more broadly can serve as foundational and adjunctive treatments alongside psychotherapy and pharmacologic care.

“Despite a growing evidence base, lifestyle interventions remain underutilized in mental health care,” said Gia Merlo, MD, MBA, MEd, DipABLM, FACLM, clinical professor of psychiatry in the NYU Grossman School of Medicine and lead author of the publication. “This consensus statement provides clinicians with clarity on where experts agree and highlights practical opportunities to improve outcomes using evidence-based lifestyle approaches.”

The panel also reached strong consensus on the importance of assessing baseline lifestyle habits, identifying social and psychological barriers—including trauma and social drivers of health—and tailoring interventions to individual readiness, access, and support systems. Nutrition-related statements emphasized the benefits of whole-food, plant-predominant dietary patterns, while cautioning against ketogenic and very low-carbohydrate diets due to insufficient evidence and known health risks.

The statement is intended to inform best practices, guide quality improvement, and identify priorities for future research. The publication is timely as depression is the leading health cause of disability worldwide, with more than 300 million individuals affected, according to the World Health Organization. The number of people with MDD increased by 18% from 2005 to 2015.

"Only half of patients with major depressive disorder achieve remission with psychotherapy and pharmacotherapy, while others improve only partially or not at all,” said Ramaswamy Viswanathan, MD, DrMedSc, DipABLM, one of the co-authors, a professor of psychiatry at SUNY Downstate Health Sciences University in Brooklyn, New York, and a past president of the American Psychiatric Association. “The addition of lifestyle interventions has a significant role to play in enhancing treatment outcomes and quality of life.”

Higher dietary thiamine intake was associated with more frequent bowel movements

 A new study, published today in Gut, spotlights vitamin B1 (thiamine) biology as an unexpected pathway for follow-up research. To explore whether this vitamin B1 signal shows up in real-world data, the researchers then turned to additional dietary information from UK Biobank. In 98,449 participants, they found that higher dietary thiamine intake was associated with more frequent bowel movements. Importantly, the relationship between thiamine intake and bowel movement frequency differed depending on a person’s genetic makeup at the SLC35F3 and XPR1 genes (analysed together as a combined genetic score). In other words, the data suggest that inherited differences in thiamine handling may influence how vitamin B1 intake relates to bowel habits in the general population.

Good Food Sources

• Whole & Fortified Grains: Enriched breads, cereals, pasta, brown rice, and wheat germ.
• Meats: Pork (especially), beef, liver, salmon.
• Legumes: Black beans, soybeans, peas.
• Nuts & Seeds: Sunflower seeds, flaxseeds, almonds, etc.. 

Why It's Important

• Energy: Helps cells convert carbohydrates into usable energy.
• Nervous System: Essential for nerve signal conduction and overall nervous system health.
• Muscle Function: Aids in muscle contraction. 

Factors Affecting Thiamine

• Loss During Processing: Milling grains removes thiamine, so enrichment is common.
• Cooking: Some thiamine is lost during cooking.
• Thiaminase: Raw fish, shellfish, coffee, and tea contain enzymes that destroy thiamine.

Deficiency & Supplements

• Deficiency (Beriberi): Can cause weakness, fatigue, confusion, and nerve damage, though rare with fortified foods.
• Supplements: Available as tablets or in B-complex/multivitamins

Mix of different types of physical activity may be best for longer life

 

Variety rather than total quantity alone linked to lower risk of early death, research suggests; But associations not linear, suggesting possible optimal threshold effect

FacebookXLinkedInWeChatBlueskyMessageWhatsAppEmail

Regularly doing a mix of different types of physical activity may be best for prolonging the lifespan, but the associations aren’t linear, pointing to a possible optimal threshold effect, suggests research published in the open access journal BMJ Medicine.

 

Variety rather than simply doing more of the same, is linked to a lower risk of death irrespective of total quantity, the findings show, although an active lifestyle is still important in its own right, emphasise the researchers.

 

While physical activity has consistently been associated with better physical and mental health and a lower risk of death, the evidence for the potential impact of different types of physical activity is less conclusive, explain the researchers. And it’s not clear whether variety might trump quantity, they add.

 

To explore this further, they drew on data from 2 large cohort studies with repeated physical activity assessments over more than 30 years: the Nurses' Health Study (121,700 female participants) and the Health Professionals Follow-Up Study (51,529 male participants).

 

Participants in both groups reported their personal characteristics, medical history, and lifestyle information on enrolment, and subsequently every 2 years by completing questionnaires.

 

In both groups, information on walking, jogging, running, cycling (including stationary machines), lap swimming, rowing or callisthenics, tennis and squash or racquetball were recorded from 1986 onwards.

 

Questions on weight training or resistance exercise; lower intensity exercise, such as yoga, stretching, and toning; other vigorous activities, such as lawn mowing; moderate intensity outdoor work, such as maintenance and gardening; and heavy intensity outdoor work, such as digging and chopping, were all added subsequently.

 

Participants were also asked how many flights of stairs they climbed daily, assuming that each flight takes 8 seconds to ascend.

 

The analysis of total physical activity levels was based on 111,467 participants: 70,725 from the Nurses' Health Study and 40,742 from the Health Professionals Follow-Up Study. Analysis of physical activity variety was based on 111,373 participants: 70,725 women and 40,648 men.

 

The researchers calculated the MET score for each physical activity by multiplying the average time (in hours/week) spent on it by its MET value. METs measure how much more energy is burned during an activity than at rest.

 

The maximum number of individual physical activities was 11 in the Nurses' Health Study and 13 in the Health Professionals Follow-Up Study. Walking was the most frequent type of leisure physical activity in both groups; men were more likely to jog and run than women.

 

Participants with higher total physical activity levels were less likely to have health risk factors, including smoking, high blood pressure and high cholesterol. They were also more likely to weigh less (lower BMI) to drink alcohol, eat healthily, to be more socially integrated, and engage in a broader range  of physical activity.

 

During the monitoring period of more than 30 years, 38,847 people died, 9901 from cardiovascular disease, 10,719 from cancer, and 3,159 from respiratory disease.

 

Total physical activity and most individual types of physical activity, except for swimming, were associated with a lower risk of death from any cause. But the associations weren’t linear, and the associations for total physical activity levelled off after reaching 20 weekly MET hours, suggesting that there might be an optimal threshold, say the researchers.

 

Walking was associated with the lowest risk of death at 17% for those who did the most walking, compared with those who did the least, while climbing stairs was associated with a 10% lower risk.

 

The associations observed for the other types of physical activity (least vs most) were as follows: tennis, squash, or racquetball 15% lower risk; rowing or callisthenics 14% lower risk; weight training or resistance exercises 13% lower risk; running 13% lower risk; jogging 11% lower risk; and cycling 4% lower risk.

 

Greater variety of physical activity was associated with a lower risk of death. After adjustment for quantity, engaging in the broadest range of physical activity was associated with a 19% lower risk of death from all causes and a 13-41% lower risk of death from cardiovascular disease, cancer, respiratory disease, and other causes.

 

This is an observational study, and as such, no definitive conclusions can be drawn about cause and effect. And the researchers acknowledge various limitations to their findings. For example, physical activity data were self-reported, rather than being objectively measured.

 

MET scores were also assigned assuming active engagement, and the lack of information on intensity may therefore have misclassified true energy expenditures. And participants were mainly White, which might limit the generalisability of the findings, they suggest.

 

Nevertheless, the researchers conclude: “Overall, these data support the notion that long term engagement in multiple types of physical activity may help extend the lifespan