McWhinney S, Kolenic M, Franke K, et al. - Patients with schizophrenia show high prevalence of obesity, with implications for psychiatric prognosis, possibly through links between obesity and brain structure. Researchers conducted this longitudinal study in the first episode of psychosis (FEP) with the aim to study the impact of psychotic illness and obesity on brain ageing/neuroprogression shortly after illness onset. Machine learning and structural magnetic resonance imaging (MRI) were used to perform this study. Two prospective MRI scans on average 1.61 years apart were acquired in 183 FEP and 155 control individuals. Relative to controls, a higher initial BrainAGE was recorded for individuals with FEP, but with similar annual rates of brain ageing over time. Patients with psychosis already exhibit brain alterations during the first episode and their worsening occurs over time in those with worsening clinical outcomes or higher baseline BMI. Baseline BMI was predictive of faster brain ageing, hence, obesity may represent a modifiable risk factor in FEP that is correlated with psychiatric outcomes via effects on brain structure.