About

John A. Batsis, MD, is an Associate Professor in the Division of Geriatric Medicine at UNC School of Medicine and also holds a joint appointment in the Department of Nutrition. His clinical and research interests focus on the synergistic impact of obesity and low muscle mass and strength (sarcopenia) on outcomes relevant to older adults, including physical function and mortality. His recent work emphasizes translating large-dataset epidemiology-based research into clinical trials involving older adults, particularly focusing on body composition changes during weight loss efforts. Dr. Batsis leverages his clinical experience in outpatient and nursing home settings to inform his research, which involves developing and applying technology to enhance health, function, and quality of life in older populations. He engages in transdisciplinary team science, with a focus on health technology, telemedicine, and remote monitoring to improve care for aging populations.

Research topics

• Medicine
• Gerontology
• Internal medicine
• Intensive care medicine
• Computer Science
• Psychiatry
• Physical therapy
• Mathematics
• Statistics
• Environmental health

Selected publications

• Effect of Incretin-Based and Nonpharmacologic Weight Loss on Body Composition

  Annals of Internal Medicine · 2026-04-17 · 1 citations

  article1st authorCorresponding

  BACKGROUND: Incretin-based therapies induce substantial weight loss and are widely prescribed; disproportionate losses in fat-free mass (FFM) and skeletal muscle are a concern. PURPOSE: To evaluate body composition changes associated with incretin therapies in adults with obesity. DATA SOURCES: Scopus, Embase (Elsevier), PubMed (National Institutes of Health, National Library of Medicine), CINAHL, PsycINFO (EBSCOhost), and ClinicalTrials.gov from January 2003 to February 2026. STUDY SELECTION: English-language randomized controlled trials reporting body composition outcomes of liraglutide, semaglutide, tirzepatide, or dulaglutide therapy in adults (aged ≥18 years). DATA EXTRACTION: Primary outcomes included changes in fat mass, FFM, lean soft tissue (LST), muscle-related indices, and visceral adiposity measured by bioelectrical impedance analysis (BIA), dual-energy x-ray absorptiometry (DXA), computed tomography (CT), or magnetic resonance imaging (MRI). Prespecified benchmarks were applied to contextualize expected muscle-related losses (about 25% of total weight loss for FFM or LST derived from BIA or DXA, and about 15% for skeletal muscle measured by CT or MRI). DATA SYNTHESIS: . Weight loss was consistently larger in the incretin intervention groups than in placebo or lifestyle intervention comparators and was consistently accompanied by reductions in total fat mass and visceral adiposity. The degree of muscle-based losses varied widely; no study reported objective physical function outcomes. Within the incretin groups across agents and measurement methods, the median proportion of total weight loss attributable to reductions in muscle-based indices was 34.9% (IQR, 19.0% to 48.2%), with 68% exceeding the benchmark of about 25%; among studies using BIA or DXA, the median was about 34.9% (IQR, 17.0% to 46.9%) of total weight loss, with 65% exceeding the 25% benchmark, and in studies using CT or MRI, the median was about 35.8% (IQR, 29.8% to 50.4%), all exceeding the 15% benchmark. In contrast, the 14 studies reporting weight loss in the lifestyle or placebo comparator groups accounted for a median weight loss of -2.4% (IQR, -4.4% to 1.0%), 50% of which exceeded the respective benchmark. LIMITATION: Heterogeneous body composition methods and reporting precluded meta-analysis. CONCLUSION: Loss of muscle-related indices exceeded prespecified benchmarks in two thirds of incretin-based interventions and half of nonpharmacologic interventions that produced weight loss. Future trials are needed to better understand mechanisms underlying these changes and their clinical implications. PRIMARY FUNDING SOURCE: None. (Open Science Framework: https://doi.org/10.17605/OSF.IO/S3A5E).

  PublisherDOI

• EffectS of Lifestyle Interventions in Older PEople With Obesity (Effective SLOPE): a Systematic Review With Network Meta‐Analyses

  University of Regensburg Publication Server (University of Regensburg) · 2026-01-01

  articleOpen access

  Background/Aim We conducted a systematic review with network meta-analyses (NMA) summarizing the effects and safety of lifestyle interventions containing nutrition (NUT; e.g., calorie restriction), exercise (EX; e.g., aerobic/resistance exercise) and behavior change interventions (BCI; e.g., behavioral therapy) on physical function, body composition, quality of life, psychosocial outcomes, health and adverse events in community-dwelling older adults with obesity. Methods We used the methodology proposed by Cochrane and searched six databases and one trial registry for eligible randomized controlled trials (RCTs; intervention duration ≥ 12 weeks) up to May 2022 with a full new search in MEDLINE and a re-assessment of previously identified eligible trial registry entries in October 2025. Random-effects NMA ((standardized) mean difference ((S)MD), 95% confidence intervals) were conducted if possible. Results We included 72 RCTs (n = 6716) for descriptive summaries and 54 RCTs (n = 4249) for NMA. NUT+EX+BCI improved physical function (performance batteries) compared to control (SMD 3.37 [1.76;4.97]; high certainty of evidence). NUT+EX+BCI may reduce body (MD −8.69 [−13.14;−4.25]) and fat mass (MD −6.58 [−10.44;−2.73]) while not negatively affecting fat-free mass (MD −1.38 [−3.52;0.76]) or bone mineral density (MD −0.01 [−0.05;0.02]) (evidence very uncertain). Other interventions (single/combined) may also be effective; however, effects were often imprecise. For psychosocial outcomes, quality of life, and health events, data were insufficient or too heterogeneous to derive clear results. Conclusion The evidence suggests that NUT+EX+BCI interventions are most suitable for the management of obesity in older adults. Nevertheless, further RCTs—especially in frail populations and on patient-relevant outcomes—are needed.

  PublisherOA PDFDOI

• The Association Between Urbanization and Frailty Status in China.

  UNC Libraries · 2026-01-06

  articleOpen access

  <strong>Background:</strong> A frailty index (FI) can identify individuals with frailty in a population of interest. Previous literature suggests a need for frailty assessment methods for older adults in China and that urbanization may impact frailty status. We used a FI to examine the association between frailty and urbanization as living in a less urbanized area may put older adults at a higher risk frailty and poor healthcare outcomes. <strong>Methods:</strong> We included adults aged 55 years and older (<em>n</em> = 7695) from the China Health and Nutrition Survey (2018). The FI was based on health outcomes correlating with a deficit score divided by number of health items: robust (&lt;0.08), pre-frail (0.08-0.24), and frail (&ge;0.25). We used multinomial logistic regression models to examine associations between urbanization tertile (low, medium, and high) and frailty, using our novel FI. We also conducted sub-analyses examining how urbanization level modifies the relationship between frailty status and region of residence, and education and income levels. <strong>Results:</strong> Living in an area of low versus high urbanization was associated with higher odds of frail versus robust (1.5; 1.2-2.0), and pre-frail versus robust (1.6; 1.4-2.0) status in the fully adjusted model. Generally, higher odds of worse frailty status (e.g., pre-frail or frail) was associated with lower tertiles of urbanization for region, income, and education when compared to the highest urbanization tertile. <strong>Conclusions:</strong> A FI can help identify specific characteristics that may benefit from individualized interventions to counteract frailty. Living in less urbanized areas was associated with higher odds of pre-frailty and frailty. Inclusion of urbanization level, geographic residence, and social determinants of health in FI development can help identify older adults most at risk of frailty and contribute to individual and policy-level frailty prevention interventions.

  PublisherDOI

• Obesity is always a clinically relevant chronic disease

  Eating and Weight Disorders - Studies on Anorexia Bulimia and Obesity · 2026-04-18

  articleOpen access

  Interest in obesity has grown exponentially over the last years, with the availability of highly effective new pharmacological treatment options. The increasing use of pharmacological treatment options has stimulated debates on several fundamental issues, including (1) full recognition of obesity as a disease, and (2) optimization of the diagnostic criteria of obesity and the timing for offering different treatment options. We aim at critically discussing here the similarities, discrepancies, and potential misunderstandings suggested by the European Association for the Study of Obesity (EASO) and Lancet Diabetes Endocrinology Commission statements. In particular, two aspects are discussed: (1) the BMI limitations and the necessity to include visceral fat and, more in general, body composition assessment in the diagnosis of obesity; (2) the opportunity to consider obesity always as a clinically relevant chronic disease due to its biological, psychological, and social characteristics.

  PublisherOA PDFDOI

• Meeting physical activity guidelines in conjunction with higher protein intake: associations with appendicular lean soft tissue index in middle aged adults with cancer

  Supportive Care in Cancer · 2026-01-01

  articleOpen access

  Abstract Background Loss of muscle mass is a common concern among patients with cancer. The aim of this study was to examine whether meeting the World Health Organization physical activity guidelines in combination with a higher vs. lower than the recommended daily allowance (RDA) protein intake is associated with greater appendicular lean soft tissue index (ALSTI) in adults aged 40–59 years with cancer from the National Health and Nutrition Examination Survey. Methods Participants were categorized by physical activity levels (moderate ≥ 150 min/week or vigorous ≥ 75 min/week) and protein intake (&gt; 0.8 vs. ≤ 0.8 g/kg/day) assessed via two interviewer-administered 24-h dietary recalls. ALSTI was calculated using dual-energy X-ray absorptiometry (kg/m 2 ). Linear regression models estimated associations, adjusting for demographic, clinical, and dietary covariates. Results Among 169 participants (mean age 51.0 ± 5.6 years; 69% women, mean ALSTI 7.74 ± 1.66 kg/m 2 ), those meeting vigorous or moderate physical activity guidelines with higher protein intake did not show a significant association with ALSTI in the fully adjusted models (vigorous: β = 0.08, standard error (SE) 0.12, p = 0.53; moderate: β = -0.05, SE 0.15, p = 0.76). However, a significantly positive link was found in those meeting both vigorous and moderate physical activity (β = 0.40, b SE 0.02, p &lt; 0.01). Conclusions Meeting vigorous or moderate physical activity guidelines in combination with higher vs. lower protein intake was not associated with ALSTI in adults with cancer. However, meeting both was positively linked to ALSTI. Longitudinal and interventional studies using objective measures and longitudinal designs are needed to clarify the role of physical activity with adequate protein intake in preserving muscle health in this clinical population.

  PublisherOA PDFDOI

• Should the Incretin hype be the same for older adults: Promise + cautions

  UNC Libraries · 2026-04-21

  articleOpen access

  Older adults are the fastest growing segment of the population with individuals classified as having body mass index-defined obesity now exceeding 40% of this demographic in the United States. Clinical and biological heterogeneity is a hallmark of an aging population who are at marked risk of long-term morbidity, disability, and mortality. Lifestyle interventions focusing on calorie restriction, changes in dietary quality, along with aerobic and resistance exercise have not only led to clinically significant weight loss, but in older adults, also have demonstrated significant improvements in physical function&mdash;a key measure of long-term health that prevents the onset of frailty and disability. Yet, Medicare-covered intensive behavior therapy for obesity remains underutilized with only 1.2% of eligible clinicians providing such services. Despite the robust benefits of lifestyle interventions in older adults, emerging anti-obesity medicines, including incretin therapies such as the glucagon-like peptide-1 (GLP-1) receptor agonists and the glucose-depending insulinotropic polypeptides (GIP), are increasingly being considered in treating persons with diabetes and obesity, notwithstanding the dearth of studies in this population. Early GLP-1s were first FDA approved in 2005 for the treatment of type 2 diabetes and then in 2021 for chronic weight management. More recently, GIP combined with GLP-1 have recently been approved as well. These classes of incretins are increasingly and widely being covered in persons with diabetes&mdash;however, there is an increased pressure now being levied to third-party payors, including Medicare, to expand coverage for an indication of weight loss in adults with obesity without diabetes.

  PublisherDOI

• Using Voice Assistant Systems to Improve Dietary Recall among Older Adults: Perspectives of Registered Dietitians

  UNC Libraries · 2026-04-18

  articleOpen access

  Dietary assessments are important clinical tools used by Registered Dietitians (RDs). Current methods pose barriers to accurately assess the nutritional intake of older adults due to age-related increases in risk for cognitive decline and more complex health histories. Our qualitative study explored whether implementing Voice assistant systems (VAS) could improve current dietary recall from the perspective of 20 RDs. RDs believed the implementing VAS in dietary assessments of older adults could potentially improve patient accuracy in reporting food intake, recalling portion sizes, and increasing patient-provider efficiency during clinic visits. RDs reported that low technology literacy in older adults could be a barrier to implementation. Our study provides a better understanding of how VAS can better meet the needs of both older adults and RDs in managing and assessing dietary intake.

  PublisherDOI

• Intrinsic capacity–frailty phenotypes and subclinical inflammation in community-dwelling octogenarians: A cross-sectional analysis from the ilSIRENTE study

  Experimental Gerontology · 2026-01-06 · 4 citations

  articleOpen access

  Chronic low-grade inflammation contributes to frailty and functional decline in aging. Intrinsic capacity (IC), defined as the composite of physical and mental reserves, complements frailty assessment by reflecting functional resilience. This cross-sectional analysis used baseline data from the ilSIRENTE cohort to examine the relationship between IC–frailty phenotypes and systemic inflammation in community-dwelling octogenarians and identify IC domains most closely related to inflammatory burden. IC was assessed across five domains (locomotion, cognition, vitality, psychological well-being, and sensory function), rescaled to a 0–100 range, and combined with frailty status to define four IC–frailty phenotypes (concordant frail, discordant low IC, discordant high IC, concordant robust). Plasma C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) were measured, and a composite inflammatory burden score (0–3) was derived. The analysis included 311 participants (mean age 85.4 ± 4.7 years, 66.6 % women). Median CRP, IL-6, and TNF-α levels increased progressively from concordant robust to concordant frail groups ( p < 0.01). In the fully adjusted model, concordant frail participants had higher inflammation compared with concordant robust (β = 0.71; 95 % CI 0.04–1.37; p = 0.03), while discordant high IC and discordant low IC showed intermediate values without statistical significance. A significant linear trend was observed across ordered phenotypes (β per category increment = 0.21, 95 % CI 0.06 to 0.37). Locomotion and vitality emerged as the domains most strongly linked to inflammation. IC–frailty phenotypes show a biological gradient of subclinical inflammation, with higher IC having lower inflammation levels. Preserved locomotion reflects key functional correlates of resilience and vitality in advanced age. • Intrinsic capacity–frailty phenotypes display a biological inflammation gradient. • Reduced intrinsic capacity is associated with elevated CRP, IL-6, and TNF-α levels. • Locomotion and vitality drive the link between functional decline and inflammation. • Results suggest impaired resilience as a pathway of inflammaging in late life. • Integrating intrinsic capacity with biomarkers refines geroscience models of aging.

  PublisherDOI

• The Integration of Lifestyle Modification Advice and Diet and Physical Exercise Interventions: Cornerstones in the Management of Obesity with Incretin Mimetics

  Obesity Facts · 2025-11-18 · 4 citations

  articleOpen access

  BACKGROUND: The introduction of incretin mimetics (IMs), including glucagon-like peptide-1 receptor agonists (GLP-1 RAs) such as liraglutide and semaglutide, as well as dual GLP-1/glucose-dependent insulinotropic polypeptide receptor co-agonists (GLP-1/GIP RAs) like tirzepatide, has revolutionized obesity treatment. These obesity management medications promote significant weight loss with metabolic and cardiovascular improvements. However, pharmacotherapy alone seems insufficient to address the multifactorial nature of obesity. While IMs suppress appetite and reduce caloric intake, they do not prevent potential nutrient deficiencies and possible loss of skeletal muscle mass, nor do they guarantee lasting behavioral changes necessary for long-term weight management, particularly in the absence of other complementary interventions. SUMMARY: In this context, a clear distinction must be made between general lifestyle modification advice (Ls-M) and personalized and structured dietetic and physical exercise interventions (D-PE-Is). Ls-M, including a balanced diet and regular physical activity, is essential for preventing obesity and reducing the risk of weight gain and associated metabolic disorders. However, once obesity is established, D-PE-I becomes necessary. Unlike Ls-M, D-PE-I integrates personalized nutritional strategies with structured exercise to maximize fat loss, preserve skeletal muscle mass and function, and enhance metabolic health. This narrative and concept-driven review aimed to delineate key areas for future clinical trials and meta-analyses. KEY MESSAGES: IMs have brought important progress in the management of obesity, contributing meaningfully to current therapeutic approaches. However, pharmacotherapy alone is not sufficient to ensure long-term success. While lifestyle advice may aid in prevention, structured and personalized dietetic and physical exercise interventions are essential once obesity is established. Their integration with IMs is crucial to support long-term weight maintenance and improve overall health and quality of life.

  PublisherDOI

• Cog-TiPRO: Iterative Prompt Refinement with LLMs to Detect Cognitive Decline via Longitudinal Voice Assistant Commands

  2025-12-08 · 1 citations

  articleOpen access

  Early detection of cognitive decline is crucial for enabling interventions that can slow neurodegenerative disease progression. Traditional diagnostic approaches rely on labor-intensive clinical assessments, which are impractical for frequent monitoring. Our pilot study investigates voice assistant systems (VAS) as non-invasive tools for detecting cognitive decline through longitudinal analysis of speech patterns in short and unstructured voice commands. Over an 18-month period, we collected voice commands from 35 older adults, with 15 participants providing daily at-home VAS interactions. To address the challenges of analyzing these short, unstructured and noisy commands, we propose Cog-TiPRO, a framework that combines (1) LLM-driven iterative prompt refinement for linguistic feature extraction, (2) HuBERT-based acoustic feature extraction, and (3) transformer-based temporal modeling. Using iTransformer, our approach achieves 73.80% accuracy and 72.67% F1-score in detecting MCI, outperforming its baseline by 27.13%. Through our LLM approach, we identify linguistic features that uniquely characterize everyday command usage patterns in individuals experiencing cognitive decline.

  PublisherOA PDFDOI

Recent grants

• COVID Extension: Mobile Health Obesity Wellness Intervention in Rural Adults

  NIH · $1.1M · 2022–2023

Frequent coauthors

• Stephen J. Bartels

  Massachusetts General Hospital

  211 shared

• Curtis L. Petersen

  Dartmouth College

  124 shared

• Todd A. MacKenzie

  Dartmouth Institute for Health Policy and Clinical Practice

  90 shared

• Francisco López-Jiménez

  Mayo Clinic

  77 shared

• Karen L. Fortuna

  Dartmouth College

  62 shared

• David Kotz

  Dartmouth College

  57 shared

• Summer B. Cook

  52 shared

• Matthew C. Lohman

  University of South Carolina

  49 shared

Awards & honors

• Best Paper Award 2019, International Conference on Body Area…
• New Hampshire’s Top Doctors 2019-20, Internal Medicine
• TidesWell Leadership Development Program Scholar 2019-21
• American Geriatrics Society/UCSF Presidential Poster Award W…
• American Geriatrics Society Service Award for Research Commi…