Examining the factor structure of health-related quality of life in spinal cord injury using confirmatory factor analysis and multidimensional scaling.

Almost half the adult population worldwide is estimated to be overweight or obese, and forecasting projects a 30% increase over the next 30 years []. Obesity is considered a threat to global health progress [] and is associated with substantial individual, community and population level costs []. However, achieving a sustained loss sufficient to improve metabolic outcomes is challenging. The majority of lifestyle and dietary interventions are associated with relatively poor adherence and have limited effect [–]. Bariatric surgery can provide sustained weight loss for selected populations, but surgical morbidity, mortality and the need for reoperation is not insignificant []. Pharmacotherapies for weight loss have been available for decades; however, the recent development of novel glucagon-like peptide-1 receptor agonists (GLP-1RA) has changed the landscape for obesity treatment []. GLP-1RAs demonstrate sustained reductions in weight, body mass index (BMI) and waist circumference, as well as improving obesity comorbidities [, ]. Studies have demonstrated between 5 and 19% reduction of body weight for participants over 52 weeks associated with GLP-1RA usage, greater in long-acting therapies and with the more recently available dual glucose-dependent insulinotropic polypeptide (GIP)/GLP-1RAs [, ]. Unsurprisingly, there has been considerable uptake of these therapies, with a 2025 United States survey reporting around 12% of adults having tried a GLP-1RA and an additional 14% expressing interest in doing so []. Peripheral nerve complications associated with significant weight loss were described by Paget in 1876, who reported on fibular neuropathy occurring in individuals with weight loss secondary to chronic infection []. Weight loss related neuropathies have also occurred in the context of intentional dieting, anorexia nervosa, starvation, cancer, thyrotoxicosis and weight loss surgery [–]. Postulated risk factors include rate, duration, and total amount of weight loss, as well as nutritional deficiency and comorbid medical concerns [, , ], with one study highlighting those losing more than 5 kg over a period of one month being at particular risk []. The spectrum of nerve disorders described includes mononeuropathy, distal sensory polyneuropathy and plexopathy. Although improvement with supportive care is seen in many, the majority of cases report long-term residual deficits [].