Waist Size Joins the Checkup

Several updates this week point to risks that often stay hidden during routine care: waist size, dental inflammation, medication burden, and heart risk in fatty liver disease.

BMI, or body mass index, is a height-and-weight calculation. It can be useful, but it does not show where fat is stored. That matters because abdominal fat is more closely tied to insulin resistance, blood pressure, cholesterol problems, and fatty liver risk than weight alone.

The AHA report said U.S. adult obesity rose from 30% in 1999 to about 40% to 41% in 2023, while severe obesity doubled from 5% to 10% over the same period. 1 The bigger patient signal is abdominal obesity: the report said abdominal obesity rose from 48% in 1999 to 61% in 2023, and youth abdominal obesity tripled. 1

Gallup's survey gives the same conversation a current-treatment angle. In a May 28 to June 5, 2026 survey of 5,065 U.S. adults, 11% said they were currently taking GLP-1 medicines for weight loss, up from 3% in 2024, and 15% said they had ever used them for weight loss. 2 Gallup also reported that the adult obesity rate fell to 36.4% in 2026 from a 39.9% high in 2022, while the diabetes rate leveled off after 15 years of increases. 2

A GLP-1 is one tool inside a bigger care plan that may include nutrition, activity, sleep, blood pressure control, cholesterol treatment, liver testing, and mental-health support.

At your next visit, ask whether your clinic can record waist circumference in a consistent way. If you already track weight at home, bring the pattern rather than one isolated number. The conversation is more useful when your clinician can compare your weight trend with the risk markers already in your chart.

The dental finding is preliminary, but it is useful because it connects two body systems that patients often have to manage separately. Researchers presenting at AHA's Basic Cardiovascular Sciences meeting reported that repeated exposure to live Porphyromonas gingivalis, a bacterium associated with gum disease, led to bacterial buildup in mouse aortic valves, more valve calcification, and signs of aortic stenosis. 4 Aortic stenosis means the aortic valve has narrowed, which can make the heart work harder to pump blood.

This mouse study should not be read as proof that dental care prevents valve disease in people. It is a reason to make dental inflammation visible in the medical chart, especially for patients with heart disease, diabetes, valve disease, bleeding gums, or delayed dental care.

The other heart update is about medicines. The AHA scientific statement on cardiovascular polypharmacy said guideline-directed treatment often requires several drugs because many patients have overlapping conditions. 3 Polypharmacy means using multiple medicines; it can be appropriate, but it can also create side effects, interactions, confusing schedules, and prescribing cascades, where one medicine is added to treat the side effect of another.

Patients should not stop heart medicines on their own. The AHA statement described deprescribing as an active, patient-centered strategy that can be considered after adverse drug events or when polypharmacy, prescribing cascades, poor adherence, or changed goals make a medication review necessary. 3

For the visit, bring the real list: prescription drugs, over-the-counter pain relievers, supplements, sleep aids, vitamins, inhalers, eye drops, and medicines you take only sometimes. Ask which medicines are still necessary, which ones need monitoring, and which ones might be making another problem worse.

Blood pressure also had two practical updates. In an Epic Research analysis of 1,743,715 adults ages 40 to 79 with stage 1 hypertension, the 2025 guideline approach raised treatment eligibility from 45.2% under the 2017 guideline to 47.0%. 6 The same analysis found that 3.2% of patients would have a treatment-plan change, with net increases concentrated among adults ages 60 to 69 and women. 6

For people whose blood pressure stays high despite treatment, Pharmacy Times reported on baxdrostat, also called Baxfendy, as a selective aldosterone synthase inhibitor for resistant hypertension. 7 Aldosterone is a hormone that can raise blood pressure by affecting salt and fluid balance. If your readings stay high on several medicines, ask whether your clinician considers your case resistant hypertension and what should be checked before adding or changing therapy.

The GLP-1 conversation keeps widening. Gallup reported that 68% of current GLP-1 users said they used brand-name medicines, 19% said they used compounded or custom-mixed versions, and 12% were unsure. 2 Among people using compounded versions, 35% had switched from brand-name drugs; among those switchers, 66% cited cost or insurance coverage as the main reason. 2

For patients, the safety question is concrete. Ask your prescriber and pharmacist the exact name of the drug, the dose, whether it is FDA-approved, which pharmacy is dispensing it, and what side effects should trigger a call. If cost pushed you toward a compounded version, say that directly. Your clinician cannot help with a safer plan if the cost problem stays hidden.

The second diabetes update is about adults who may not fit the usual type 2 diabetes pattern. HCPLive reported that more than half of new type 1 diabetes cases occur in adults, while clinical practice and training have often treated type 1 diabetes as a childhood disease. 8 The same report said adults with type 1 diabetes are often misdiagnosed as having type 2 diabetes. 8

Most adults with type 2 diabetes have type 2 diabetes. Still, a person whose blood sugar rises quickly, who loses weight unexpectedly, who needs insulin sooner than expected, or who has other autoimmune disease can ask whether testing for type 1 diabetes markers is appropriate. The goal is to avoid months of treatment that does not match the biology.

MASLD stands for metabolic dysfunction-associated steatotic liver disease. Many people still call it fatty liver disease. MASH is the inflammatory form that can lead to scarring. These conditions often travel with diabetes, high blood pressure, abnormal cholesterol, sleep apnea, and higher cardiovascular risk.

That is why the heart-risk update matters. GastroEndoNews reported that common cardiovascular risk tools may not predict heart events well in people with MASLD, and the report noted that about 40% to 50% of deaths in MASLD are related to cardiovascular disease. 5 Patients should not treat that report as a new scoring rule. They should use it to ask whether their liver diagnosis is being included in the heart-risk discussion.

A separate Clinical Chemistry review discussed blood-based biomarkers for noninvasive MASLD assessment, including markers used to evaluate liver fibrosis and fat buildup. 9 Biomarkers are measurable signs in blood or tissue. In liver care, they are often used with scores, imaging, and clinical history to decide who needs closer monitoring or referral.

If you have MASLD, diabetes, abnormal liver enzymes, or a family history of liver disease, ask what your clinic is using to estimate fibrosis risk. Many patients hear "fatty liver" for years without knowing whether scarring risk has been checked.

Alcohol-related hepatitis had a different kind of update. A Spanish REHALC registry study across 28 centers and 577 patients found that people who reached liver recompensation after alcohol-related hepatitis had 84.9% five-year transplant-free survival, compared with 47.7% among people with persistent decompensation. 10 Recompensation means liver function has improved after a period of decompensation, when complications such as fluid buildup, confusion, bleeding risk, or jaundice may appear.

The appointment question is specific: "What would improvement look like for me, and which labs, symptoms, alcohol-use supports, nutrition goals, and follow-up visits tell us whether my liver is recompensating?" For caregivers, that question can make follow-up less vague.