Background: Adipose tissue, carotid intima-media thickness (CIMT), and carotid plaque (CP) are predictors of cardiovascular disease. However, previous studies examining the associations of visceral fat area (VFA) or subcutaneous fat area (SFA) with CIMT or CP have reported inconsistent results. We investigated the associations of computed tomography-derived adipose tissue distribution (VFA, SFA, and the VFA/SFA ratio), as well as body mass index (BMI) and waist circumference (WC), with carotid atherosclerosis, increased CIMT (≥1.0 mm), and CP. Methods: A total of 1,502 men and 1,290 women who underwent comprehensive health examinations between 2020 and 2024 were included. Sex-specific associations of VFA, SFA, the VFA/SFA ratio, BMI, and WC with carotid atherosclerosisrelated outcomes were evaluated using multivariable logistic regression models adjusted for age, lifestyle factors, serum uric acid levels, metabolic comorbidities, and menopausal status (in women). Additionally, age-stratified subgroup analyses were performed by categorizing participants into <60 and ≥60 years. Results: The mean age of participants was 60 years. Carotid atherosclerosis was present in 68.04% of men and 55.04% of women. Among men, each 0.1-unit increase in the VFA/SFA ratio was positively associated with carotid atherosclerosis (odds ratio [OR] 1.037; 95% confidence interval [CI], 1.001 to 1.075) and CP (OR 1.037; 95% CI, 1.001 to 1.075). In women, WC was positively associated with increased CIMT (OR 1.041; 95% CI, 1.004 to 1.078), mainly among those aged ≥60 years. Conclusion: Our findings suggest sex- and age-specific associations between adiposity measures and carotid atherosclerosis-related outcomes, providing insights into the relationship between fat distribution and vascular health.

Background: White blood cell (WBC) count is a widely used marker of systemic inflammation. Chronic low-grade inflammation has been implicated in impaired natural killer (NK) cell function. However, factors modifying this relationship remain unclear. Because abdominal obesity is associated with chronic inflammation, it may be a key modifier. This study examined whether abdominal obesity modifies the association between WBC count and NK cell activity. Methods: This cross-sectional, single-center study included 1,646 adults who underwent health examinations at Yongin Severance Hospital, Korea (2017-2024). NK cell activity was measured using the NK Vue^® Kit. Abdominal obesity was defined as waist circumference ≥90 cm in men and ≥85 cm in women. Multivariable logistic regression analysis was performed, adjusting for age, sex, and body mass index (BMI). Restricted cubic spline analysis was used to assess the dose-response relationship. Effect modification was evaluated using interaction terms (P for interaction <0.10). Results: Higher WBC count was associated with low NK cell activity (odds ratio [OR] 1.25, P<0.001), with a monotonically increasing dose-response relationship (P for nonlinearity = 0.689). In stratified analyses, the association was stronger in the non-abdominal obesity group (Q4 OR 2.73, P<0.001) than in the abdominal obesity group (Q4 OR 2.14, P = 0.030), with evidence of interaction (P for interaction = 0.096). BMI-defined obesity showed no significant interaction (P = 0.496). Conclusion: Higher WBC count was associated with low NK cell activity in a health screening cohort. This association was attenuated in individuals with abdominal obesity, suggesting that abdominal obesity may modify the relationship between systemic inflammation and NK cell function.

Background: Neck circumference (NC) is a simple marker of upper-body adiposity; however, whether NC or height-adjusted NC (neck-to-height ratio, NC/Ht ratio) better identifies metabolic syndrome (MetS) and whether the optimal index differs by sex remains unclear. Methods: This cross-sectional study analyzed 10,451 adults (4,685 male participants; 5,766 female participants) aged ≥40 years from the 2019-2021 Korea National Health and Nutrition Examination Survey. MetS was defined using the modified NCEP-ATP III criteria. The discriminatory performances of the two indices were compared using receiver operating characteristic curve analysis with DeLong's test, and the optimal cutoffs were determined using the Youden index with bootstrap confidence intervals. Sex-stratified multivariate logistic regression was adjusted for age, body mass index, alcohol use, smoking, and physical activity. Results: Both indices were higher in the MetS group for both sexes (all P<0.001). NC showed superior discrimination in male participants (area under the curve, 0.733 vs. 0.708, P<0.001), whereas the NC/Ht ratio outperformed NC in female participants (0.755 vs. 0.733, P<0.001). The optimal cutoffs were an NC of 37.9 cm for male and an NC/Ht ratio of 20.92 for female participants. The highest versus the lowest quartile was associated with higher odds of prevalent MetS (male participants: odds ratio, 2.99 for NC; female participants: 5.00, for NC/Ht ratio). Conclusion: The sex-specific use of these indices, NC for male and the NC/Ht ratio for female participants, may enhance MetS screening in this population. Further prospective validation is required.

Background: This study aimed to investigate the factors associated with changes in serum testosterone levels following weight loss among young males with obesity. Methods: This retrospective observational study included 79 males aged 20-39 years selected from 465 patients with obesity who visited a hospital for weight reduction and underwent at least two serum testosterone measurements during follow-up. Pearson's correlation analysis evaluated associations between total serum testosterone levels and anthropometric and metabolic parameters. Multiple linear regression analysis identified independent factors associated with changes in total testosterone levels following weight loss. Results: The mean age of the participants was 30.3 ± 5.5 years, body weight was 102.0 ± 16.2 kg, waist circumference was 105.0 (99.0-114.5) cm, and body mass index was 32.9 ± 4.5 kg/m². Following the weight-loss intervention, mean serum testosterone levels increased significantly (3.21 ± 1.34 ng/mL vs. 3.89 ± 1.45 ng/mL; P<0.001). Changes in total testosterone levels were inversely correlated with changes in body weight-related parameters, hemoglobin A1c levels, and triglyceride levels. Multiple linear regression analysis demonstrated that changes in waist circumference were independently associated with changes in serum testosterone levels (β = -0.609, P = 0.001). Conclusion: Reduced waist circumference was independently associated with increased serum testosterone levels. These findings suggest that reduction of abdominal obesity may be associated with improved serum testosterone levels.

Obesity is a chronic disease associated with increased risks of metabolic disorders, cardiovascular disease, cancer, impaired quality of life, and premature mortality. Recent advances in anti-obesity pharmacotherapy, particularly glucagon-like peptide-1 (GLP-1) receptor agonists and dual GLP-1/glucose-dependent insulinotropic polypeptide receptor agonists, have substantially improved weight-loss outcomes and demonstrated significant cardiometabolic benefits. These developments have shifted the treatment paradigm from a focus on weight reduction to broader improvements in health outcomes. However, the history of anti-obesity medications highlights the importance of balancing treatment efficacy with long-term safety. Several agents, including fenfluramine, sibutramine, and lorcaserin, were withdrawn because of serious adverse events identified during clinical use or post-marketing surveillance. In addition, the emergence of highly effective pharmacotherapies has raised important ethical questions regarding obesity medicalization, lifelong pharmacotherapy, treatment accessibility, health equity, obesity stigma, and the role of social determinants of health. Issues related to patient autonomy and shared decision-making have also become increasingly relevant in the GLP-1 era. This review examines the evolution of anti-obesity treatments, the changing risk-benefit balance of contemporary obesity management, and the major ethical challenges associated with modern obesity care. A balanced approach integrating clinical effectiveness, long-term safety, patient-centered decision-making, and social responsibility is essential to achieve sustainable and equitable obesity treatment.

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and dual glucose-dependent insulinotropic polypeptide (GIP)/GLP-1 receptor agonists are key pharmacological therapies for obesity and type 2 diabetes mellitus. Although these agents provide substantial metabolic and weight-loss benefits, they are frequently associated with adverse gastrointestinal events and delayed gastric emptying, raising concerns about residual gastric contents and aspiration risk during endoscopic and surgical procedures. Semaglutide and tirzepatide commonly induce nausea, vomiting, diarrhea, and constipation, particularly during dose-escalation periods. Delayed gastric emptying is mediated through vagal pathways and suppression of gastric motility in a dose-dependent manner. Emerging evidence suggests that standard fasting durations may not reliably ensure an empty stomach in patients receiving GLP-1 RAs, and several studies have reported increased residual gastric contents, gastroparesis, intestinal obstruction, and aspiration-related events associated with these medications. In response, recent guidelines from the anesthesiology and gastroenterology societies have shifted from routine drug discontinuation to individualized risk-based management strategies. Patients with gastrointestinal symptoms, during the dose-escalation period, receiving high-dose or weekly GLP-1 RA therapy, or with comorbid conditions affecting gastric motility are considered at a higher risk. Recommended approaches include a preprocedural 24-h liquid diet, point-of-care gastric ultrasonography, rapid-sequence induction, and airway-protective measures in select patients. Current recommendations emphasize individualized risk stratification rather than universal discontinuation of therapy, although further prospective studies are needed to establish evidence-based peri-procedural management protocols for patients receiving GLP-1 RAs.