Medical Bulletin 17/September/2025

Repetitive negative thinking refers to the persistent habit of dwelling on worries about the future or regrets about the past. For years, scientists have speculated that these thought patterns might influence brain health, but recent evidence strengthens that link. The Wuhan study involved 424 adults aged 60 and above and measured RNT using the Perseverative Thinking Questionnaire (PTQ), while cognitive performance was assessed through the Montreal Cognitive Assessment Scale (MoCA).

Participants were divided into four quartiles based on their repetitive negative thinking scores. Those in the highest two quartiles—indicating more frequent negative thinking—scored significantly lower on cognitive tests than those in the lowest quartile. This difference remained even after adjusting for other factors like age, education, income, chronic diseases, and lifestyle variables. Subgroup analysis showed that the association was particularly strong in people aged 60–79 and those with at least junior high school education.

The possible mechanisms include prolonged stress responses, depletion of mental resources (a “cognitive debt”), and biological changes in the brain. While the Wuhan study is cross-sectional and can’t establish causality, it highlights a key modifiable risk factor. Importantly, strategies such as mindfulness, cognitive behavioral therapy (CBT), and lifestyle improvements may help mitigate these risks.

Reference: Ye, N., Peng, L., Deng, B. et al. Repetitive negative thinking is associated with cognitive function decline in older adults: a cross-sectional study. BMC Psychiatry 25, 562 (2025). https://doi.org/10.1186/s12888-025-06815-2

Enhanced Efficacy of High-Dose Semaglutide in Obesity and Type 2 Diabetes: STEP UP Trials Find

A higher weekly dose of semaglutide (7.2 mg) may offer a powerful new treatment for obesity, delivering significantly greater weight loss and health benefits than the currently approved dose, according to two international phase 3 clinical trials published in The Lancet Diabetes & Endocrinology. The STEP UP and STEP UP T2D trials suggest that this increased dosage could be particularly effective for adults with obesity, including those with type 2 diabetes (T2D), who have not achieved sufficient weight reduction with existing therapies.

Semaglutide, a GLP-1 receptor agonist originally developed to manage diabetes, has already demonstrated weight loss benefits at lower doses. These new trials are the first to test whether increasing the dose from 2.4 mg to 7.2 mg is both safe and more effective. Participants in the trials were randomly assigned to receive either the 7.2 mg dose, the standard 2.4 mg dose, or a placebo over a 72-week period. All groups also received lifestyle interventions such as dietary counseling and increased physical activity.

In adults without diabetes, those receiving the 7.2 mg dose lost an average of nearly 19% of their body weight—compared to 16% with the 2.4 mg dose and 4% with placebo. Nearly half of the participants on the higher dose lost 20% or more of their body weight, with about one-third losing at least 25%. Improvements were also seen in blood pressure, blood sugar, cholesterol, and waist circumference. In adults with obesity and T2D, the higher dose led to an average 13% weight loss versus 10% with 2.4 mg and 3.9% with placebo, along with significant metabolic improvements.

The higher dose was generally well tolerated, with the most common side effects being gastrointestinal issues like nausea and diarrhoea, and occasional tingling sensations. “Most side effects were manageable, resolved over time, and did not lead to participants dropping out of the trial.” Importantly, there was no increase in serious adverse events or hypoglycaemia with the higher dose.

In conclusion, the findings point to a potentially transformative option for managing obesity and related health risks. While long-term effects still need further study, the results mark a significant step forward in the treatment of obesity and T2D.

Reference: Once-weekly semaglutide 7·2 mg in adults with obesity (STEP UP): a randomised, controlled, phase 3b trial, Wharton, Sean et al., The Lancet Diabetes & Endocrinology, Volume 0, Issue 0

Acupuncture May Ease Chronic Back Pain and Boost Function in Older Adults

A new study published in the Journal of the American Medical Association (JAMA) Internal Medicine reveals that older adults with chronic low back pain who received acupuncture experienced greater improvements in physical function and pain reduction compared to those who received only standard medical care. The findings offer encouraging evidence for a safe, non-addictive alternative to manage one of the most common and disabling conditions in aging populations.

The clinical trial, known as BackInAction, enrolled 800 participants aged 65 and older who had experienced low back pain for at least three months. All participants continued their usual medical care, but two-thirds were randomly assigned to receive acupuncture treatments—either 15 sessions over three months or those plus six additional maintenance sessions over the next three months.

Researchers assessed participants at three, six, and 12 months using self-reported disability scores based on their ability to perform everyday activities. They also collected data on pain intensity, physical function, anxiety, and depression. “Our clinical results suggest that acupuncture is working as well as many things that are more familiar to people. We found that the size of this effect, while modest, was positive and sustained,” said lead author Lynn L. DeBar, Ph.D., a distinguished investigator at Kaiser Permanente.

At both the six- and 12-month marks, participants who received acupuncture reported significantly lower disability and pain scores compared to those receiving only usual care. They also showed improvements in anxiety symptoms and physical function.

In conclusion, the BackInAction trial highlights acupuncture as a viable, low-risk treatment that could enhance pain management strategies for older adults. Researchers stress the importance of expanding Medicare coverage to improve access to this underutilized therapy.

Reference: “Acupuncture for Chronic Low Back Pain in Older Adults: A Randomized Pragmatic Clinical Trial” 2025. JAMA Network Open. DOI: 1E0.1001/jamanetworkopen.2025.31348