Obesity Imperative
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VA/DoD 2025 Obesity Guidelines

Jack Cush, MD

Annals of Internal Medicine has published the updated 2025 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guidelines on adult Overweight and Obesity management. Here is a review of the guidelines, including five key takeaways for rheumatologists.

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Rheumatology Pay Up (9.25.2026)

Jack Cush, MD

Dr. Jack Cush reviews the news and journal reports from this past week on RheumNow.com.

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Estimated > 7million Americans (~1/3 US GLP1 Rxs) get GLP-1 drugs from online compounding source- but these are not FDA approved. They maybe cheaper, but dosing/quality is suspect. FDA needs to close the 503B loophole to outlaw these copycat Rxs https://t.co/Xu7MeP0Ytt https://t.co/nYGr3auqzx

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Prescribing New GLP-1-Based Therapies https://t.co/cpxyxBMZ8s https://t.co/9JXmlW2Lj6

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QD Clinic: GLP-1s and History of Thyroid Cancer? Daric Mueller, PA-C, St. Clair Shores, MI, presents this case as part of RheumNow's "The Obesity Imperative" campaign, presented in September 2026. https://t.co/rhsUNVIdQ4 https://t.co/mjHEWNIGqU

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QD Clinic: Bariatric Surgery "Curing" Arthritis? Dr. Richard Conway, Dublin, presents this QD Clinic as part of RheumNow's "The Obesity Imperative" campaign, presented in September 2026. https://t.co/YwtSkroMta https://t.co/tl8eSrvGhq

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Obesity in Rheumatic Diseases: More than just a Comorbidity https://t.co/0QJ188HYSm https://t.co/3L09m2cowl

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Obesity and Psoriatic Disease

Mason Arbabi, MD and Juliana S. Simonetti, MD

Obesity is a clinically important comorbidity in psoriasis and psoriatic arthritis. Excess adiposity contributes to systemic inflammation and cardiometabolic risk and may adversely affect disease severity and response to some systemic therapies. Intentional weight loss should be considered an

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Study of 119 Rheum pts on GLP-1 Rx (65% T2DM, 35% obesity; mean BMI 35). @ 12 mos wt loss −7.7 kg & 56% improved ≥1 BMI category. Signif decr in A1c, FBS, lipids, LDL, TG, ESR & CRP. GLP-1RAs useful cardiometabolic benefits https://t.co/fdNtvGu8Vb~ https://t.co/EdAqXfsjW0

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Lifestyle and Incretin Therapy Advice for Rheumatologists

Jack Cush, MD

As GLP-1/GIP receptor agonists become standard co-management tools for obese patients with RA, PsA, axSpA, and gout, this JAMA Insights perspective by Kushner, et al. reframes lifestyle counseling as an adjunct to pharmacotherapy - a reversal of the traditional model. This has with direct

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Discussing Weight Loss: 3 Minute Script Dr. Jack Cush's 3 Minute Script as discussed in his Introducing Weight Loss video. https://t.co/JRWAPc5if5 https://t.co/jI65VzTIfs

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Obesity and Rheumatic Disease Presented as part of RheumNow's "The Obesity Imperative" campaign. https://t.co/d2fl4EJX8Q https://t.co/AZGfKRvZrx

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Join us for Tuesday Nite Rheumatology on September 22 for: Obesity Treatment & Safety Experts will tackle: • GLP-1/GIP therapies • Lifestyle & bariatric interventions • Treatment selection & safety • Cost & compounding concerns • Sarcopenia & bone health • The future of https://t.co/BCSOUot5FL
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Early RA Referral Clinics Work (9.18.2026)

Jack Cush, MD

Dr. Jack Cush reviews the news and journal reports from this past week on RheumNow.com

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Bariatric Surgery in the Era of GLP-1RA Overweight/obesity is a chronic multi-system disease that can impair physical and mental health. It now affects almost 1 in 3 Canadians. Multiple recent guidelines have therefore suggested using waist measurements, in addition to BMI, to https://t.co/RaXnQ2d9Yr
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QD Clinic: GLP-1s and History of Thyroid Cancer? Daric Mueller, PA-C, St. Clair Shores, MI, presents this case as part of RheumNow's "The Obesity Imperative" campaign, presented in September 2026. https://t.co/uob8RlMV14 https://t.co/f42gB0IXl1

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Dr. John Cush @RheumNow( View Tweet )
Obesity management goes far beyond the number on the scale. Watch our Four Pillars of Weight Loss video series, part of this month’s The Obesity Imperative campaign. What Are the Four Pillars of Obesity Management? Building a Multidisciplinary Program for Obesity & Arthritis https://t.co/16v4JFVWWs
Dr. John Cush @RheumNow( View Tweet )
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Obesity and Gout: An Old Relationship with New Thoughts

Willa Hsueh, MD

Current recommendations are that obesity management is an integral component of gout treatment and that, in parallel, gout awareness is an important component in the treatment of the metabolic syndrome.

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QD Clinic: Bariatric Surgery "Curing" Arthritis? Dr. Richard Conway, Dublin, presents this QD Clinic as part of RheumNow's "The Obesity Imperative" campaign, presented in September 2026. https://t.co/M6nKr9EShU https://t.co/6JX5bCYzfo

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Dr. John Cush @RheumNow( View Tweet )
Obesity Journal Club: Tuesday Nite Rheumatology The Obesity Journal Club explores the TOGETHER PsA and STEP 9 trials and what emerging evidence tells us about the relationship between obesity, weight loss, and rheumatic disease. Panelists discussed the results of these trials, https://t.co/3C1RLyRj0b
Dr. John Cush @RheumNow( View Tweet )
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ACR Updates Osteoarthritis Guidance

ACR

The American College of Rheumatology (ACR) has released updated clinical guidance for the treatment and management of osteoarthritis (OA) of the knee, hip, and hand. The evidence-based recommendations update the 2019 ACR/Arthritis Foundation guideline and are designed to support individualized,

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Discussing Weight Loss: 3 Minute Script Dr. Jack Cush's 3 Minute Script as discussed in his Introducing Weight Loss video. https://t.co/JRWAPc5if5 https://t.co/NUpxPT4bdo

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Dr. John Cush @RheumNow( View Tweet )
Weight Loss Improves Psoriatic Disease Substantially! Even before the introduction of incretin therapy and bariatric surgery, many randomized and interventional studies (2019–2026) have consistently showed that weight loss produces clinically meaningful, dose-dependent https://t.co/BWeW7fzSC8
Dr. John Cush @RheumNow( View Tweet )
In 2022, Overweight & obesity affect 65.8% of Swiss PsA pts (vs gen pop.= 43%) and has increased since 2007. Obesity was assoc w/ elevated CRP (56% vs 37%), Inc Pt global assess (3.2 vs 2.8), & MD global (2.5 vs 2.1) & lower EQ-5D-3L(0.7 vs 0.8). https://t.co/xPoy4dgvlD https://t.co/aeB5N6LgCd

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Obesity in Axial Spondyloarthritis: what are we missing beyond the scale? Obesity in axSpA is not a minor comorbidity. While obesity is more often discussed in psoriatic arthritis (PsA) due to the psoriasis-adipose tissue link which is mechanistically better studied and https://t.co/bFkoPmc0pC
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Therapeutic Updates

The Four Pillars of Weight Loss

RheumNow
Nutrition and Weight Management in Rheumatic Disease
Watch our 'Four Pillars of Weight Loss' 6-part series as part of this month's The Obesity Imperative campaign.
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Recent Blogs

rheumthought

Do You Have to be Overweight for GLP-1s to Work?

Janet Pope, MD, MPH, FRCPC
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Are there any data that GLP-1 RA drugs can be effective if a person has a normal BMI? 

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rheumthought

Obesity in Rheumatic Diseases: More than just a Comorbidity

Marina Magrey, MD
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A few years ago, when I would see a patient with rheumatic disease and increased BMI, I would often document it as obesity as a comorbidity, recommend weight loss and exercise, and then move on. My approach has changed.
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rheumthought

Obesity and Lupus: Coconspirator or Comorbidity?

Alfred Kim, MD, PhD
Dr. Al Kim

Dr. Al Kim, St. Louis, discusses the effects of obesity on lupus activity, organ damage, complement levels and mTor activation.

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Podcasts

  • Obesity Treatment & Safety
  • The Four PIllars of Weight Loss Part 2
  • The Four Pillars of Weight Loss Part 1

Daily Gem

Obesity medications are powerful tools, but when combined with lifestyle interventions, they can take us even further. 

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