Weight Loss Outcomes Associated With Semaglutide Treatment for Patients With Overweight or Obesity

What is the Role of Primary Prevention of Obesity in an Age of Effective Pharmaceuticals?

PURPOSE OF REVIEW

To examine the evidence and continuing role of strategies for the primary prevention and treatment of obesity in the context of effective obesity pharmacotherapies, through a narrative review.

RECENT FINDINGS

Global policies to improve nutritional labelling and reduce sugar-sweetened beverages consumption have been implemented worldwide (> 45 countries) with some success which varies by population and environment. Tailored behavioural interventions are effective and essential to reduce individual risk of progression from preclinical to clinical obesity. Pharmacotherapies are powerful treatment agents for clinical obesity but must consider nutritional and metabolic risks of use and discontinuation. The obesogenic environment continues to undermine individual agency to adopt healthier dietary and physical activity patterns. Population health informatics tools could inform tailored interventions based on real-time risk and contribute to obesity prevention and treatment. Efforts to rebalance investment towards obesity prevention must continue to improve population health and reduce healthcare burden.

Real-world use and effectiveness of tirzepatide among people without evidence of type 2 diabetes in the United States

AIM

To understand treatment patterns and effectiveness of tirzepatide among people without type 2 diabetes (T2D) in the US.

METHODS

This retrospective, observational, descriptive study used the Healthcare Integrated Research Database (index date: first-observed tirzepatide claim; index period: May 13, 2022-May 24, 2023). Key eligibility criteria were: age ≥ 18 years; ≥ 1 tirzepatide claim; no T2D diagnosis codes or glycated hemoglobin ≥ 6.5 %, no anti-diabetes medications (except metformin); and continuous medical/pharmacy enrollment for ≥ 12 months pre-index (Overall cohort). Tirzepatide persistence and utilization (6-months post-index) were assessed among obesity management medication (OMM)-eligible individuals (body mass index [BMI] ≥ 30 kg/m2, or ≥ 27 kg/m2 with ≥ 1 obesity-related complication [ORC]; OMM-eligible cohort). Tirzepatide effectiveness was assessed among individuals who were OMM-eligible, naive to glucagon-like peptide-1 receptor agonists, and persistent on tirzepatide for ≥6 months (Persistent+GLP-1 naive cohort).

RESULTS

The overall cohort included 4,177 individuals with mean age 46.0 years, 75.6 % female, and mean BMI 37.1 kg/m2. At baseline, 73.8 % of individuals had ≥ 1 ORC while 51.0 % had ≥ 2 ORCs. Persistence in the OMM-eligible cohort was 73.8 %; by the sixth prescription fill, 56.2 % were receiving < 10 mg tirzepatide. Individuals in the Persistent+GLP-1 naive cohort with pre- and post-index weight and BMI measurements (n = 200) achieved mean weight reduction of 12.9 % at 6-months post-index (≥ 5 %: 88.5 %; ≥ 10 %: 69.0 %).

CONCLUSION

Real-world evidence suggests multimorbidity among tirzepatide initiators, slower tirzepatide dose escalation than in clinical trials, and clinically meaningful weight reduction among people persisting on tirzepatide for ≥ 6 months.

Advances in incretin therapies for targeting cardiovascular disease in diabetes

The global prevalence of obesity is skyrocketing at an alarming rate, with recent data estimating that one-in-eight people are now living with the disease. Obesity is a chronic metabolic disorder that shares underlying pathophysiology with other metabolically-linked diseases such as type 2 diabetes mellitus, cardiovascular disease and diabetic cardiomyopathy. There is a distinct correlation between type 2 diabetes status and the likelihood of heart failure. Of note, there is an apparent sexual dimorphism, with women disproportionately affected with respect to the degree of severity of the cardiac phenotype of diabetic cardiomyopathy that results from diabetes. The current pharmacotherapies available for the attenuation of hyperglycaemia in type 2 diabetes are not always effective, and have varying degrees of efficacy in the setting of heart failure. Insulin can worsen heart failure prognosis whereas metformin, sodium-glucose cotransporter 2 inhibitors (SGLT2i) and more recently, glucagon-like peptide-1 receptor agonists (GLP-1RAs), have demonstrated cardioprotection with their administration. This review will highlight the advancement of incretin therapies for individuals with diabetes and heart failure and explore newly-reported evidence of the clinical usefulness of GLP-1R agonists in this distinct phenotype of heart failure.

Obesity: pathophysiology and therapeutic interventions

Over the past few decades, obesity has transitioned from a localized health concern to a pressing global public health crisis affecting over 650 million adults globally, as documented by WHO epidemiological surveys. As a chronic metabolic disorder characterized by pathological adipose tissue expansion, chronic inflammation, and neuroendocrine dysregulation that disrupts systemic homeostasis and impairs physiological functions, obesity is rarely an isolated condition; rather, it is frequently complicated by severe comorbidities that collectively elevate mortality risks. Despite advances in nutritional science and public health initiatives, sustained weight management success rates and prevention in obesity remain limited, underscoring its recognition as a multifactorial disease influenced by genetic, environmental, and behavioral determinants. Notably, the escalating prevalence of obesity and its earlier onset in younger populations have intensified the urgency to develop novel therapeutic agents that simultaneously ensure efficacy and safety. This review aims to elucidate the pathophysiological mechanisms underlying obesity, analyze its major complications-including type 2 diabetes mellitus (T2DM), cardiovascular diseases (CVD), non-alcoholic fatty liver disease (NAFLD), obesity-related respiratory disorders, obesity-related nephropathy (ORN), musculoskeletal impairments, malignancies, and psychological comorbidities-and critically evaluate current anti-obesity strategies. Particular emphasis is placed on emerging pharmacological interventions, exemplified by plant-derived natural compounds such as berberine (BBR), with a focus on their molecular mechanisms, clinical efficacy, and therapeutic advantages. By integrating mechanistic insights with clinical evidence, this review seeks to provide innovative perspectives for developing safe, accessible, and effective obesity treatments.

Association between plausible genetic factors and weight loss from GLP1-RA and bariatric surgery

Obesity is a major public health challenge. Glucagon-like peptide-1 receptor agonists (GLP1-RA) and bariatric surgery (BS) are effective weight loss interventions; however, the genetic factors influencing treatment response remain largely unexplored. Moreover, most previous studies have focused on race and ethnicity rather than genetic ancestry. Here we analyzed 10,960 individuals from 9 multiancestry biobank studies across 6 countries to assess the impact of known genetic factors on weight loss. Between 6 and 12 months, GLP1-RA users had an average weight change of -3.93% or -6.00%, depending on the outcome definition, with modest ancestry-based differences. BS patients experienced -21.17% weight change between 6 and 48 months. We found no significant associations between GLP1-RA-induced weight loss and polygenic scores for body mass index or type 2 diabetes, nor with missense variants in GLP1R. A higher body mass index polygenic score was modestly linked to lower weight loss after BS (+0.7% per s.d., P = 1.24 × 10-4), but the effect attenuated in sensitivity analyses. Our findings suggest known genetic factors have limited impact on GLP1-RA effectiveness with respect to weight change and confirm treatment efficacy across ancestry groups.

Real-world evidence on the utilization, clinical and comparative effectiveness, and adverse effects of newer GLP-1RA-based weight-loss therapies

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have emerged as key agents for weight management, based on their marked efficacy as observed in randomized controlled trials. While still limited, real-world studies on GLP-1RA use in populations with obesity are increasingly available. This narrative review discusses contemporary real-world evidence demonstrating the utilization, clinical and comparative effectiveness, and adverse effects of the currently approved GLP-1RA-based weight-loss therapies, that is, liraglutide, semaglutide and tirzepatide. The observed weight reduction in clinical practice overall tends to be lower than in randomized controlled trials; however, outcomes approach those seen in trials when focusing on highly adherent patients. Real-world studies demonstrate high discontinuation rates of GLP-1RAs (20%-50%) within the first year, and the use of much lower doses than those evaluated in clinical trials. Evidence from observational studies within type 2 diabetes or obesity populations suggests frequent gastrointestinal disturbances in GLP-1RA users, as also observed in trials, but no clear increase in risks of severe events like pancreatitis or pancreatic cancer, thyroid disorders, or depression and self-harm. Further evidence is needed to understand possible real-world associations of GLP-1RAs with eye disease and other rare outcomes. We provide 10 areas of particular importance for further research on GLP-1RA within the real-world space, including improved understanding of the exact drivers of early discontinuation and suboptimal dosing, studies of the effects of stopping GLP-1RA treatment, and investigations of clinical and cost-effectiveness for hard clinical outcomes in real-world settings, including not only cardio-reno-metabolic outcomes but also obesity-induced diseases like neuropsychiatric disease, cancer, musculoskeletal disease, and infections. PLAIN LANGUAGE SUMMARY: Recent advancements in weight-loss medications have sparked a lot of interest. The so-called GLP-1 receptor agonist medications (GLP-1RAs) have gained a lot of attention, because they have shown to be very effective, leading to significant weight loss in patients participating in clinical trials. GLP-1RAs, like liraglutide, semaglutide, and tirzepatide, help manage weight by mimicking hormones that control blood sugar and appetite. However, how these medications perform in real life can be different from the controlled settings of clinical trials, in which patients are carefully selected and their treatment plans closely followed. This literature review looks at how these medications are used and their effectiveness and safety in real-world settings. In real-life practice, GLP-1RAs are often less effective than in clinical trial conditions. This is usually because patients don't follow their medication plans as strictly as in trials. Real-world data shows that many patients use lower doses and do not stick to their treatment as strictly as participants in a controlled trial might, leading to less weight loss. However, those who do follow their plans closely can achieve results similar to those in trials. A major issue with GLP-1RAs is that many patients stop using them within the first year due to side effects or high costs of the medications, especially if not covered by insurance. Common side effects include nausea and digestive problems, which are the main reasons patients stop taking these treatments. These side effects are often manageable and decrease over time, and this reviews found no strong real-world evidence that GLP-1RAs cause severe side effects in many users. Despite these challenges, when GLP-1RAs are used effectively and consistently, they show substantial benefits in weight loss, most so the newest medications semaglutide and tirzepatide. These medications are also likely to help manage and prevent weight-related health conditions like type 2 diabetes and cardiovascular disease, but evidence for these beneficial outcomes is still scarce in real-world settings. The review emphasizes the need for more research to understand why many patients stop using these medications and how to improve dosing. It also calls for studies on the long-term effects of these therapies on various health outcomes, including mental health, cardiometabolic health, cancer, and rare conditions like eye diseases. Overall, while GLP-1RAs are a valuable tool for weight management, their real-world use requires careful consideration of individual patient factors, such as the ability to stick to treatment plans, manage side effects, and afford the medications. Further research will help make these treatments more effective for a wider range of people that need them.

Semaglutide 2.4 mg long-term clinical outcomes in patients with obesity or overweight: a real-world retrospective cohort study in the United States (SCOPE 12 months)

OBJECTIVES

To evaluate the effectiveness of semaglutide 2.4 mg for weight reduction and improvement in cardiometabolic biomarkers at 52 and 68 weeks in a real-world setting in the United States.

METHODS

This noninterventional, retrospective cohort study used the Komodo Health database and included adults with obesity or overweight with ≥1 weight-related condition who initiated treatment with semaglutide 2.4 mg between June 2021 and August 2022 and remained on treatment for 1 year. A paired t-test was used to assess changes in weight, body mass index (BMI), and cardiometabolic biomarkers (systolic blood pressure [SBP], diastolic blood pressure [DBP], glycated hemoglobin [HbA1c], HDL [high-density lipoprotein] cholesterol, LDL [low-density lipoprotein] cholesterol, and triglycerides) from baseline to 52-week and 68-week follow-up.

RESULTS

Among 4,424 eligible patients, 77% were women and the mean (SD) age was 46.7 (10.0) years and BMI was 36.6 (3.6) kg/m2. Dyslipidemia and hypertension were the most common obesity-related comorbidities at baseline. The mean (%) change in weight from baseline was -15.5 kg (-14.5%; p < 0.001; n = 594) at 52 weeks and -15.9 kg (-14.8%; p < 0.001; n = 391) at 68 weeks. The mean change in BMI from baseline was - 4.8 kg/m2 (n = 1124) at 52 weeks and - 4.9 kg/m2 (n = 700) at 68 weeks. At 52weeks, statistically significant improvements in mean values were observed for SBP (-6.3 mmHg), DBP (-3.1 mmHg), HbA1c (-0.4%), LDL cholesterol (-8.1 mg/dL), and triglycerides (-38.4 mg/dL) (all p < 0.001). Mean change at 52 weeks for HDL cholesterol was 1.0 mg/dL; p = 0.109. Results at 68 weeks were similar.

CONCLUSIONS

In this retrospective cohort study, the real-world effectiveness of semaglutide 2.4 mg was demonstrated by reductions in weight and BMI along with improvements in BP, HbA1c, and lipid panel among patients with obesity or overweight.

Impact of Anti-obesity Medication Initiation and Duration on Weight Loss

Introduction

Real-world studies of anti-obesity medication (AOM) use have shown lower adherence and persistence than clinical trials; however, the impact of this reduced adherence in real-world settings remains largely unexplored. This study aimed to evaluate the effects of AOM use, timing of initiation, and duration on 18-month weight loss outcomes in comprehensive obesity care practice, offering critical insights into the role of adherence in optimizing treatment efficacy.

Methods

This retrospective cohort study assessed the electronic health records of adults with a body mass index (BMI) ≥ 30 kg/m2 enrolled in a digital obesity program for ≥ 18 months. Participants were categorized by AOM use, initiation timing (early vs. delayed), and duration (short vs. long).

Results

This study of 1282 participants showed that AOM users had greater weight reduction than non-users. Long- and short-duration AOM users experienced significantly more weight loss than short-duration users, with no difference between early and delayed starters. Second-generation semaglutide users were more likely to reach the 20% weight loss milestone, especially with longer use.

Conclusion

Long-term AOM use significantly improved weight loss in comprehensive obesity care. Furthermore, the success of non-AOM users highlights the value of intensive behavioral programs, indicating the need for personalized treatment to optimize cost-effectiveness and outcomes.

The Effect of Body Mass Index on Surgical Outcomes Following Aseptic Short-Segment Revision Lumbar Fusions: A Retrospective Study

BACKGROUND

This study investigated the association among preoperative body mass index (BMI) and surgical outcomes, reoperation rate, and 1-year patient-reported outcome measures (PROMs) following 1-3 level revision lumbar fusion.

METHODS

Patients who underwent a 1-3 level revision lumbar fusion from 2011-2021 were included. Patients were grouped into BMI classes: normal (18.5-24.99), overweight (25.0-29.99), obese class 1 (30.0-34.99), and obese class 2+ (≥35.0). Demographics, surgical characteristics, 1-year reoperations, 90-day readmissions, and 1-year PROMs were compared between cohorts. PROMs included the Short Form-12 Physical Component Score, Mental Component Score, Oswestry Disability Index, Visual Analog Scale Back pain score, and Visual Analog Scale Leg pain score.

RESULTS

In total, 743 patients were identified: 115 normal weight, 254 overweight, 206 obese class 1, and 168 obese class 2+. Operative time (P = 0.007) and length of stay (LOS) (P = 0.002) were longer in patients with higher BMI. Multivariate regression demonstrated obese class 2+ was independently associated with longer operative times (estimate: 32.43; P = 0.008) and LOS (estimate: 0.68; P = 0.044). There were no differences in readmission (P = 0.285) or reoperation rates (P = 0.727). All patients received a similar benefit between preoperative and 1-year PROMs.

CONCLUSIONS

While more obese revision lumbar fusion patients experienced longer operative times and LOS, these patients ultimately experienced similar improvements from surgical intervention at 1 year postoperatively. Regardless of BMI class, all patients had comparable rates of readmission within 90 days and reoperation. These findings support previous lumbar fusion literature and suggest an indicated revision lumbar fusion in higher BMI class patients does not lead to further reoperations or worse PROMs.

Semaglutide and Postoperative Outcomes in Nondiabetic Patients Following Body Contouring Surgery

BACKGROUND

Semaglutide is a medication for weight loss in obese patients. Recently, many plastic surgeons have recommended semaglutide following bariatric surgery to increase weight loss. However, postoperative complications such as wound dehiscence, delayed healing, and infection pose significant risks.

OBJECTIVES

In this study we aimed to examine the relationship between preoperative semaglutide and postoperative complications in nondiabetic obese patients undergoing body contouring surgery. We hypothesized that semaglutide would increase the risk of postoperative complications.

METHODS

In this retrospective cohort study we utilized the TriNetX Research database. Nondiabetic patients who underwent body contouring surgery between 2021 and 2024 after bariatric procedures were included. Patients were divided into 2 cohorts: Cohort A (4215 patients), which received semaglutide for ≥6 months before surgery, and Cohort B (104,927 patients), without semaglutide. Propensity score matching was employed to create comparable cohorts based on age, gender, race, and BMI. The primary outcomes included postoperative complications within 30 days of surgery.

RESULTS

Significant differences were found between the cohorts. Semaglutide patients had higher rates of wound dehiscence (5.19% vs 2.78%, P < .0001); delayed wound healing (2.58% vs 1.21%, P < .0001); surgical site infections (5.37% vs 2.87%, P < .0001); nausea, vomiting, and diarrhea (11.27% vs 5.34%, P < .0001); hypertrophic scar formation (5.53% vs 3.86%, P = .0011); and surgical site pain (6.05% vs 3.29%, P < .0001).

CONCLUSIONS

Preoperative semaglutide in nondiabetic patients undergoing body contouring surgery following bariatric procedures is associated with higher rates of adverse postoperative outcomes. These findings highlight the need for enhanced preoperative counseling and surgical planning to minimize risks and improve patient outcomes.

LEVEL OF EVIDENCE: 3 (THERAPEUTIC)

Effectiveness and Safety of Semaglutide for Weight Loss in Patients With Inflammatory Bowel Disease and Obesity

BACKGROUND

Semaglutide, a glucagon-like peptide-1 receptor agonist, has shown sustained and clinically significant weight loss in the general population. There are limited data on outcomes of its use in patients with inflammatory bowel disease (IBD).

METHODS

A retrospective cohort study was conducted between June 4, 2021, and December 11, 2023, using TriNetX, a U.S. multi-institutional database in patients with obesity who had IBD compared with patients without IBD. The primary aim was to assess the mean total body weight (TBW) change between 6 and 15 months from initiation of semaglutide compared with baseline between the 2 cohorts. One-to-one (1:1) propensity score matching was performed for demographics, comorbid conditions, smoking status, and mean body mass index. A 2-sample t test was performed to assess mean TBW change from baseline, with a P value <.05 considered to be statistically significant. We also compared the risk of IBD-specific outcomes with and without semaglutide use in patients with IBD.

RESULTS

Out of 47 424 patients with IBD and obesity, 150 (0.3%) patients were prescribed semaglutide (mean age 47.4 ± 12.2 years; mean TBW 237 ± 54.8 pounds; mean body mass index 36.9 ± 6.5 kg/m2; 66% Crohn's disease). There was no difference in mean TBW change after initiation of semaglutide in the IBD and non-IBD cohorts (-16 ± 13.4 pounds vs -18 ± 12.7 pounds; P = .24). There was no difference in mean TBW change between 6 and 12 months (-16 ± 13 pounds vs -15 ± 11.2 pounds; P = .24) and 12 and 15 months (-20 ± 13.2 pounds vs -21 ± 15.3 pounds; P = .49) between the 2 cohorts. There was no difference in the risk of oral or intravenous steroid use and any-cause hospitalization in the semaglutide group compared with the group without semaglutide use in patients with IBD.

CONCLUSION

Semaglutide use is effective in patients with IBD and obesity similar to patients without IBD, with >5% mean weight loss. There was no increased risk of IBD-specific adverse events with semaglutide use.

Comparative effectiveness of balloons, adjustable balloons, and endoscopic sleeve gastroplasty: a network meta-analysis of randomized trials

BACKGROUND AND AIMS

Individual randomized controlled trials (RCTs) and pairwise meta-analyses do not compare all commercially available endoscopic bariatric therapies (EBTs) head-to-head. Therefore, the choice among them is currently made by inference or indirect data. We therefore assessed the comparative efficacy and safety of EBTs through a network meta-analysis.

METHODS

We searched MEDLINE, EMBASE, and Cochrane CENTRAL from inception for intragastric balloons (IGBs) and from 2013 for endoscopic sleeve gastroplasty (ESG) until May 2023. Only RCTs comparing any of the currently commercially available EBTs with controls were considered eligible. Outcomes included percentage of total weight loss (%TWL), serious adverse events (SAEs), and intolerability.

RESULTS

We identified 821 citations, of which 10 and 8 were eligible for the qualitative and quantitative analysis, respectively. Considering %TWL at the time of IGB removal, all EBTs were associated with statistically higher %TWL than controls. There were no significant differences among EBTs. However, considering the %TWL at the follow-up closest to 12 months, both ESG and the Spatz3 gastric balloon (Spatz Medical, Fort Lauderdale, Fla, USA) were more effective than the Orbera gastric balloon (Apollo Endosurgery, Austin, Tex, USA), with no statistical difference between ESG and Spatz3. For both outcomes, P score and ranking score suggested that ESG was probably associated with a greater weight loss (.889272 and .899469, respectively), followed by Spatz3 (.822894 and .842773, respectively), and Orbera (.536968 and .507165, respectively).

CONCLUSIONS

All currently available EBTs approved by the U.S. Food and Drug Administration are more effective than both diet plus lifestyle intervention and sham procedures with an acceptable safety profile. ESG seems the most effective and may be prioritized for patients fit for both ESG and IGBs. Direct controlled trials between EBTs are warranted to confirm these findings.

The impact of semaglutide on wound healing in diabetes related foot ulcer patients: A TriNetX database study

IntroductionDiabetes related foot ulcers (DFUs) are common complications of type 2 diabetes mellitus (T2DM), affecting 15-25% of individuals living with diabetes and significantly contributing to healthcare costs ($9-13 billion annually in the U.S.). Without effective management, these wounds often lead to severe outcomes like amputations. This study aims to examine the association of semaglutide on DFU management.MethodsThis retrospective cohort study utilized TriNetX US Research Network data to assess the impact of semaglutide, a GLP-1 receptor agonist, on DFU outcomes between 2013 and 2023. The study compared outcomes between semaglutide users with DFU (Cohort A, N = 6329) and non-users with DFU (Cohort B, N = 118,821) across 64 healthcare organizations. We matched participants by age, gender, race, and ethnicity; however, we excluded patients with certain co-morbidities. Statistical analysis, such as chi-square analysis and risk ratio, using TriNetX software evaluated different complication outcomes.ResultsSemaglutide users with DFU demonstrated lower relative risks for complications compared to non-users. Within 1 year, semaglutide users were associated with lower relative risks for wound healing complications (0.19% vs 0.38%), chronic non-healing wounds (0.75% vs 1.23%), chronic pain (4.44% vs 8.06%), wound care (2.42% vs 4.86%), wound dehiscence (0.26% vs 0.56%), and amputation (2.34% vs 5.21%) (p < .05). Similar trends persisted over 5 years. While these findings highlight potential benefits of semaglutide with patients with DFU, causation cannot be inferred due to the study's observational design.ConclusionSemaglutide use was associated with favorable outcomes in patients with diabetes-related foot ulcers, including reductions in wound-related complications. While these findings suggest potential benefits of semaglutide as an adjunct in DFU management, further research is needed to confirm these associations and to better understand the mechanisms involved.

Comparative Effectiveness of Semaglutide, Liraglutide, Orlistat, and Phentermine for Weight Loss in Obese Individuals: A Systematic Review

Obesity, a multifaceted and chronic condition characterized by excessive fat accumulation, poses significant risks to overall health and is associated with various metabolic and cardiovascular complications. This literature review evaluates and compares the effectiveness of four pharmacological agents semaglutide, liraglutide, orlistat, phentermine, and emerging agents like setmelanotide, amycretin, retatrutide, cagrilintide, and cotadutide in managing weight loss among obese. A detailed analysis was conducted on their mechanisms of action, dosing regimens, efficacy in weight loss, safety profiles, and their impact on obesity-related comorbidities. Although all agents presented distinct benefits, side effects such as gastrointestinal discomfort with orlistat and GLP-1 receptor agonists, and potential dependency with phentermine, necessitate tailored treatment approaches. This review highlights the importance of integrating pharmacotherapy with lifestyle interventions to achieve sustainable weight management and identifies areas for future research to optimize therapeutic outcomes for individuals with obesity.

Long-Term Weight Loss Outcomes in a Virtual Weight Care Clinic Prescribing a Broad Range of Medications Alongside Behavior Change

Background

Virtually-delivered obesity care has the potential to increase access to weight loss interventions at scale. While there is ample literature assessing various weight loss interventions, studies specifically demonstrating outcomes of commercial programs offering antiobesity medications in virtual care settings are lacking.

Methods

This retrospective cohort study assessed the weight loss outcomes of 66,094 participants in a virtual weight care program that prescribes antiobesity medications alongside a digital behavior change program. Outcomes included the primary endpoint of percent weight loss at 12 months, as well as absolute change in body weight, change in body mass index (BMI), categorical weight loss at three, six, and 12 months, and stratifications by program engagement and medication type (first vs. second generation antiobesity medications).

Results

At program enrollment, members were on average 42.6 years old and 91.5% female, with a BMI of 36.0 kg/m2. At 12 months, the mean percent weight loss was 8.0%, with weight loss increasing over time from 2.9 kg (SD = 3.7, Cohen's d = 0.8) at 3 months, to 5.8 kg (SD = 6.1, Cohen's d = 0.9) at 6 months, to 8.0 kg (SD = 8.7, Cohen's d = 0.9) at 12 months (p < 0.001 for all time points). At 12 months, 64.2% had achieved ≥ 5% weight loss. Weight loss outcomes increased with program engagement. At 12 months, those engaging at least once weekly lost 10.0% of body weight, while those logging weight at least weekly lost 12.0%.

Conclusion

This study provides real-world evidence that users of a virtual commercial weight care clinic who were prescribed antiobesity medications achieved clinically significant weight loss at six and 12 months. These findings support the value of virtual platforms in efficiently scaling access to high-quality weight care.

GLP-1RAs attenuated obesity and reversed leptin resistance partly via activating the microbiome-derived inosine/A2A pathway

Extensive evidence has demonstrated that glucagon-like peptide-1 receptor agonists (GLP-1RAs) can ameliorate obesity. Our previous studies revealed that (Ex-4)2-Fc, a long-acting GLP-1RA we developed, depends on the leptin pathway to treat obesity. However, the mechanisms linking (Ex-4)2-Fc and leptin resistance remain largely unclear. To address this question, we explored the mechanism of GLP-1RAs from the perspective of the gut microbiota, as increasing evidence indicates an important link between the gut microbiota and obesity. This study aimed to explore the potential role of the gut microbiota in the treatment of GLP-1RAs. We found that (Ex-4)2-Fc treatment reshaped obesity-induced gut microbiota disturbances and substantially increased the abundance of Akkermansia muciniphila (Am). In addition, (Ex-4)2-Fc did not respond well in antibiotic-treated (ATB) Obese mice. Subsequent studies have shown that this defect can be overcome by gavage with Am. In addition, we found that Am enhanced (Ex-4)2-Fc therapy by producing the metabolite inosine. Inosine regulates the macrophage adenosine A2A receptor (A2A) pathway to indirectly reduce leptin levels in adipocytes Thus, elucidating the role of metabolites in regulating the leptin pathway will provide new insights into GLP-1RAs therapy and may lead to more effective strategies for guiding the clinical use of antidiabetic agents.

Once-Weekly Semaglutide Versus Once-Daily Liraglutide for Weight Loss in Adults: A Meta-Analysis of Randomized Controlled Trials

The effectiveness of glucagon-like peptide-1 receptor agonists in facilitating weight loss among patients with diabetes is widely recognized. However, there are limited data available on the relative effectiveness and safety of once-weekly semaglutide versus once-daily liraglutide. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) identified through a comprehensive search of the Cochrane Library, PubMed, and ScienceDirect databases from inception until July 2024. Statistical analysis was conducted using R version 4.4.1 with the "meta" package, employing a random effects model. Three RCTs with a total of 922 patients were included in our meta-analysis. The results indicated that OW semaglutide significantly reduced body weight (WMD: -4.55; 95% CI: -6.43, -2.67, p < 0.01), HbA1c (WMD: -0.46; 95% CI: -0.84, -0.08; p = 0.02), and fasting plasma glucose levels (WMD: -1.23; 95% CI: -1.51, -0.95; p < 0.01) in comparison to OD liraglutide. The risk of severe adverse effects (OR, 1.66; 95% CI, 0.53-5.16; p = 0.38) and gastrointestinal adverse effects (OR, 1.84; 95% CI, 0.82-4.14; p = 0.14) was comparable between both groups. Once-weekly semaglutide therapy results in a more pronounced loss in body weight, HbA1c, and fasting glucose levels compared to once-daily liraglutide.

Achieving Over 30% Body Weight Loss With Semaglutide in a Patient: A Case Report

A 69-year-old female with morbid obesity (BMI: 47) and hypertension achieved significant weight loss following treatment with semaglutide. Starting at 241 lb, she lost 90 lb (over 30% of her body weight) over 65 weeks without side effects. This weight loss exceeded the average reduction reported in previous studies. Additionally, her hypertension resolved, and her glucose levels normalized, illustrating the multifaceted benefits of semaglutide in weight management.

Factors associated with weight loss response to GLP-1 analogues for obesity treatment: a retrospective cohort analysis

OBJECTIVES

The response to glucagon-like peptide-1 (GLP-1) analogues for weight loss varies significantly. We investigated the anthropometric, demographic and clinical characteristics associated with total body weight loss (TBWL) from subcutaneous GLP-1 analogue therapy in patients with obesity in a real-world setting.

DESIGN

Retrospective cohort analysis.

SETTING

An urban, multidisciplinary obesity community clinic in Vancouver, Canada, from November 2018 to April 2021.

PARTICIPANTS

483 adults with a body mass index (BMI) of ≧30 kg/m2 who had filled a new prescription for subcutaneous semaglutide or liraglutide, with at least 6-month follow-up, were included (mean follow-up: 17.3 months). Individuals with prior bariatric surgery were excluded.

OUTCOMES

The primary outcome was the %TBWL over a mean follow-up period of 520 days. Participant's TWBL was categorised as non-response (<5% TBWL), moderate response (5%-15% TBWL) or hyper-response (>15% TBWL).

RESULTS

The average %TBWL in the cohort was 12.2%. Among the participants, 17.8% had a non-response, 48.4% had a moderate response and 33.8% had a hyper-response. In the multivariable regression analysis, being a woman was associated with hyper-response (adjusted OR 1.92, CI 1.01 to 3.65, p=0.048). Age, diabetes status, baseline BMI, being sedentary, anxiety and depression were not independently associated with TBWL in response to GLP-1 analogue therapy.

CONCLUSIONS

In a real-world setting, female sex was found to be associated with a hyper-response to GLP-1 analogue therapy for obesity management. Other clinical factors evaluated, including diabetes status, were not associated with the response. Future research should assess additional variables and support the development of novel biomarkers that are associated with weight loss response.

Association between plausible genetic factors and weight loss from GLP1-RA and bariatric surgery: a multi-ancestry study in 10 960 individuals from 9 biobanks

Obesity is a significant public health concern. GLP-1 receptor agonists (GLP1-RA), predominantly in use as a type 2 diabetes treatment, are a promising pharmacological approach for weight loss, while bariatric surgery (BS) remains a durable, but invasive, intervention. Despite observed heterogeneity in weight loss effects, the genetic effects on weight loss from GLP1-RA and BS have not been extensively explored in large sample sizes, and most studies have focused on differences in race and ethnicity, rather than genetic ancestry. We studied whether genetic factors, previously shown to affect body weight, impact weight loss due to GLP1-RA therapy or BS in 10,960 individuals from 9 multi-ancestry biobank studies in 6 countries. The average weight change between 6 and 12 months from therapy initiation was -3.93% for GLP1-RA users, with marginal differences across genetic ancestries. For BS patients the weight change between 6 and 48 months from the operation was -21.17%. There were no significant associations between weight loss due to GLP1-RA and polygenic scores for BMI or type 2 diabetes or specific missense variants in the GLP1R, PCSK1 and APOE genes, after multiple-testing correction. A higher polygenic score for BMI was significantly linked to lower weight loss after BS (+0.7% for 1 standard deviation change in the polygenic score, P = 1.24×10-4), but the effect was modest and further reduced in sensitivity analyses. Our findings suggest that existing polygenic scores related to weight and type 2 diabetes and missense variants in the drug target gene do not have a large impact on GLP1-RA effectiveness. Our results also confirm the effectiveness of these treatments across all major continental ancestry groups considered.

Medical therapy to treat obesity and optimize fertility in women of reproductive age: a narrative review

BACKGROUND

Overweight and obesity-chronic illnesses in which an increase in body fat promotes adipose tissue dysfunction and abnormal fat mass resulting in adverse metabolic, biomechanical, and psychosocial health consequences-negatively impact female fertility. Adverse conception outcomes are multifactorial, ranging from poor oocyte quality and implantation issues to miscarriages and fetal health issues. However, with the advent of novel pharmacologic agents, significant weight loss can be achieved, improving the chances of healthy pregnancies, and their use should be considered during periconceptual counseling. There are currently 6 FDA-approved medications for weight loss: 2 GLP1-receptor agonists (GLP1-RAs) liraglutide and semaglutide, 1 dual GLP-1 and gastric inhibitory peptide agonist (GLP1-GIP) tirzepatide, Contrave (naltrexone/bupropion), Qsymia (phentermine/Topamax), and Xenical (orlistat). GLP1-RAs reduce food cravings, appetite, and "food noise" and improve insulin sensitivity and satiety, all of which lead to significant weight loss, ranging from 6 to 30% of starting total body weight or greater, depending on the specific agent used. Their efficacy and relative safety should make them first-line options for women seeking to lose weight in the year before trying to conceive. Contrave, the combination of naltrexone and bupropion, seems to work most significantly for weight loss by inhibiting the rewarding and reinforcing effects of food consumption. Clinical trials report ~ 6% loss of starting total body weight with use of Contrave, as well as improvement in metabolic health factors. It may also improve a woman's ability to conceive by mitigating the effects of PCOS and endometriosis and reducing the drive for alcohol and smoking. Qsymia, the combination of phentermine and topiramate, results in more weight loss than Contrave but cannot be used in the acute preconception period, as its topiramate component is a known teratogen. Orlistat is another FDA-approved medication for weight loss; however, it is currently used much less often than other anti-obesity drugs because of its relatively lower efficacy and significant side effects. Bariatric surgery, which can lead to significant weight loss (25-50%), was previously regarded as the most durable method for weight loss, before the advent of GLP1-RAs. Given the inherent risks of surgery, the development of vitamin (i.e. B12, folate, vitamin D) and mineral (i.e. iron, copper, zinc) deficiencies, that may impact the health of the mother and fetus, as well as the recommended delay of 1-2 years prior to attempting pregnancy, bariatric surgery should not be considered first-line therapy for obesity management in women of reproductive age, especially for women who are hoping to conceive quickly or are nearing advanced maternal age.

CONCLUSION

Clinically significant and meaningful weight loss is achievable with pharmacotherapy to help enhance fertility in women of reproductive age who are overweight or obese. Current research supports the use of weight loss medications for enhancing spontaneous conception and response to ovulation induction. Further research on the effects upon live birth rates are warranted. For meaningful weight loss, GLP1-RAs can be considered for use in the preconception period, as long as they are stopped at least 2 months before conception. Contrave can be considered as well, though resulting in less weight loss. Phentermine and Qsymia are teratogenic but can be used with contraception for weight loss before trying to get pregnant.

Semaglutide restores astrocyte-vascular interactions and blood-brain barrier integrity in a model of diet-induced metabolic syndrome

INTRODUCTION

Metabolic syndrome (MetS) is a metabolic disorder related to obesity and insulin resistance and is the primary determinant of the development of low-intensity chronic inflammation. This continuous inflammatory response culminates in neuroimmune-endocrine dysregulation responsible for the metabolic abnormalities and morbidities observed in individuals with MetS. Events such as the accumulation of visceral adipose tissue, increased plasma concentrations of free fatty acids, tissue hypoxia, and sympathetic hyperactivity in individuals with MetS may contribute to the activation of the innate immune response, which compromises cerebral microcirculation and the neurovascular unit, leading to the onset or progression of neurodegenerative diseases.

OBJECTIVE

This study aimed to evaluate the effects of chronic treatment with a GLP-1 receptor agonist (semaglutide) on cerebral microcirculation and neurovascular unit (NVU) integrity.

METHODS

C57BL/6 mice were fed a standard normolipidic diet or a high-fat diet (HFD) for 24 weeks and then treated for 4 weeks with semaglutide (HFD SEMA) or saline solution (HFD SAL). At the end of pharmacological treatment, biochemical analyses, immunohistochemistry analysis, and intravital microscopy of the brain microcirculation were carried out to quantify leukocyte-endothelium interactions and to assess structural capillary density, astrocyte coverage on cerebral vessels and microglial activation.

RESULTS

We observed that SEMA attenuates high-fat diet-induced metabolic alterations in mice fed with HFD for 24 weeks. SEMA also reversed cerebral microcirculation effects of HFD by reducing capillary rarefaction and the interaction of leukocytes in postcapillary brain venules. The HFD-SEMA group exhibited improved astrocyte coverage on vessels. However, SEMA did not reverse microglial activation.

CONCLUSIONS

Semaglutide can reverse microvascular rarefaction in metabolic syndrome by restoring the integrity of the neurovascular unit. Adverse dietary stimuli can compromise microglial homeostasis that is not reversed by semaglutide.

Perioperative Medicine for Ambulatory Surgery

Ambulatory anesthesia for same-day surgery is a fast-growing and ever-improving branch of modern anesthesia. This is primarily driven by the involvement of anesthesiologists as perioperative physicians working in multidisciplinary groups. These groups work together to improve patient safety, patient outcomes, and overall efficiency of both in-patient and out-patient surgery. Appropriate patient selection and optimization are critical to maintain and improve the foundational entities of best ambulatory anesthesia practice. In this review article, a selection of considerations in the field of ambulatory anesthesia are featured, such as the aging population, sleep apnea, obesity, diabetes, cardiac disease, substance abuse, preoperative medication management, multimodal analgesia, social determinants of health, and surgical facility resources.

Searching the Crystal Ball for Tailored GLP-1 Receptor Agonists Treatment in Type 2 Diabetes and Obesity

BACKGROUND

Glucagon-like peptide 1 receptor agonists (RA) are novel agents used in the management of type 2 diabetes (T2D) and obesity. Although highly effective, the response to treatment may vary significantly among patients.

OBJECTIVE

This perspective review aims to summarise the current knowledge about markers of poor or good response to GLP-1 RA, highlighting the possibility of tailoring treatment strategies and reducing costs associated with T2D and obesity treatment.

METHODS

A comprehensive literature search was conducted using PubMed, NCBI, and Scopus databases, focussing on studies published between 2016 and 2024 that evaluated factors influencing treatment outcomes with GLP-1 RA.

RESULTS

Several markers, including baseline HbA1c levels, ghrelin and glucose-dependent insulinotropic polypeptide (GIP) levels, specific gut microbiome composition, b-cell function, and genetic markers, were identified as factors associated with treatment response.

CONCLUSION

Understanding predictive markers of response to therapy can enhance precision-based medicine for the selection of patients eligible for GLP-1 RA, improving clinical outcomes and optimising diabetes management.

Intrapatient Changes in CT-Based Body Composition After Initiation of Semaglutide (Glucagon-Like Peptide-1 Receptor Agonist) Therapy

BACKGROUND. The long-acting glucagon-like peptide-1 receptor agonist semaglutide is used to treat type 2 diabetes or obesity in adults. Clinical trials have observed associations of semaglutide with weight loss, improved control of diabetes, and cardiovascular risk reduction. OBJECTIVE. The purpose of this study was to evaluate intrapatient changes in body composition after initiation of semaglutide therapy by applying an automated suite of CT-based artificial intelligence (AI) body composition tools. METHODS. This retrospective study included adult patients who were receiving semaglutide treatment and who, between January 2016 and November 2023, underwent abdominopelvic CT within both 5 years before and 5 years after initiation of semaglutide. An automated suite of previously validated CT-based AI body composition tools was applied to scans obtained before semaglutide initiation (hereafter, presemaglutide scans) and scans obtained after semaglutide initiation (hereafter, postsemaglutide scans) to quantify visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) area, skeletal muscle area and attenuation, intermuscular adipose tissue (IMAT) area, liver volume and attenuation, and trabecular bone mineral density (BMD). Patients with weight loss of 5 kg or more and those with weight gain of 5 kg or more between the scans were compared. RESULTS. The study included 241 patients (151 women and 90 men; mean age, 60.4 ± 12.4 [SD] years). In the weight-loss group (n = 67), the postsemaglutide scan, compared with the presemaglutide scan, showed a decrease in VAT area (309.4 vs 341.1 cm2, p < .001), SAT area (371.4 vs 410.7 cm2, p < .001), muscle area (179.2 vs 193.0, p < 0.001), and liver volume (2379.0 vs 2578 HU, p = .009) and an increase in liver attenuation (74.5 vs 67.6 HU, p = .03). In the weight-gain group (n = 48), the postsemaglutide scan, compared with the presemaglutide scan, showed an increase in VAT area (334.0 vs 312.8, p = .002), SAT area (485.8 vs 448.8 cm2, p = .01), and IMAT area (48.4 vs 37.6, p = .009) and a decrease in muscle attenuation (5.9 vs 13.1, p < .001). Other comparisons were not statistically significant (p > .05). CONCLUSION. Patients using semaglutide who lost versus gained weight showed distinct patterns of changes in CT-based body composition measures. Those with weight loss had overall favorable shifts in measures related to cardiometabolic risk. A decrease in muscle attenuation in those with weight gain is consistent with decreased muscle quality. CLINICAL IMPACT. Among patients using semaglutide, automated CT-based AI tools provide biomarkers of changes in body composition beyond those that are evident by standard clinical measures.

Glucagon-like Receptor-1 agonists for obesity: Weight loss outcomes, tolerability, side effects, and risks

Background

This review investigates the side effects of glucagon-like peptide-1 receptor agonists (GLP-1RAs) like liraglutide, semaglutide, and tirzepatide, medications known for their efficacy in promoting weight loss among individuals with obesity. The rationale is rooted in understanding the balance between their therapeutic benefits and associated risks.

Methods

This was a comprehensive clinical review, including systematic reviews, meta-analyses, randomized controlled trials (RCTs), and cohort studies. Data were extracted from databases such as PubMed, Scopus, Embase, MEDLINE, and Google Scholar, focusing on the tolerability, severity, and risks of these medications.

Results

GLP-1RAs demonstrated significant weight loss outcomes. In clinical trials, liraglutide showed a placebo-corrected weight loss of around 5 %, semaglutide 12 %, and tirzepatide 18 %. Common side effects were predominantly gastrointestinal, including nausea, diarrhea, constipation, and vomiting. Rare serious adverse events included gallbladder disorders and acute pancreatitis. In, addition, multiple studies identify new risks associated with GLP-1RAs including increased aspiration risk during anesthesia due to delayed gastric emptying and challenges with bowel preparation for colonoscopies.

Conclusion

While GLP-1RAs are effective in managing obesity, their use is associated with gastrointestinal side effects and rare but serious adverse events. The findings underscore the importance of individualized dosing and thorough patient assessment. Continuous research and vigilant monitoring are essential to optimize their safe use. Further studies are needed to refine guidelines, particularly regarding new concerns such as delayed gastric emptying and its implications for anesthesia.

Efficacy of antiobesity medications among breast cancer survivors taking aromatase inhibitors

PURPOSE

Aromatase inhibitors (AI) block estrogen synthesis and are used as long-term adjuvant treatment for breast cancer in postmenopausal women. AI use can be associated with weight gain that can lead to increased cardiometabolic risk. The response to anti-obesity medications (AOM) in patients using AI has yet to be studied. We sought to investigate weight loss outcomes of AOM in patients taking AI for breast cancer treatment.

METHODS

This is a matched retrospective cohort study of breast cancer survivors on AI using AOM (AOM/AI group). We compared their weight loss outcomes with a group of female patients with obesity, without a history of breast cancer or AI use, on AOM (AOM group). The primary endpoint was total body weight loss percentage (TBWL %) at the last follow-up. We performed mixed linear regression models, including diabetes status at baseline, to assess associations between use of AOM with/without AI with total body weight loss percentage (TBWL%).

RESULTS

We included 124 patients: 62 in the AOM/AI group (63.6 ± 10 years, body mass index [BMI] 34.3 ± 7.1 kg/m2) and 62 in the AOM group (62.8 ± 9.9 years, BMI 34.6 ± 6.5 kg/m2). The mean time of follow up was 9.3 ± 3.5 months, with no differences among the two groups. The AOM/AI group had a lower TBWL% compared to the AOM group at the last follow-up -5.3 ± 5.0 vs. -8.2 ± 6.3 (p = 0.005). The results remained significant after adjusting for diabetes status (p = 0.0002). At 12 months, the AOM/AI group had a lower TBWL% compared to the AOM group 6.4 ± 0.8% vs. 9.8 ± 0.9% (p = 0.04). The percentage of patients achieving ≥ 5%, ≥ 10%, and ≥ 15% of weight loss at 12 months was greater in the AOM compared to the AOM/AI group. Although the weight loss response was suboptimal, patients in the AOM/AI group had improvement in fasting glucose, glycated hemoglobin, systolic blood pressure, and low-density lipoprotein cholesterol.

CONCLUSIONS

The use of AI in breast cancer survivors is associated with less weight loss response to AOM compared to patients without breast cancer history and who do not take AI. Studies are needed to assess the mechanisms behind the differential weight loss response to AOM in women taking AI.

Efficacy and safety of semaglutide: real-world tertiary care experience from Saudi Arabia

BACKGROUND

Semaglutide, a glucagon-like peptide-1, is an effective antidiabetic drug promoting weight loss and providing cardiovascular protection. The original trials did not include participants from Saudi Arabia; hence, the study's findings are expected to be useful.

OBJECTIVES

Explore the efficacy, safety, and favorable effects of once-weekly subcutaneous semaglutide (1 mg) in patients with type 2 diabetes and those who received it as an off-license prescription without having diabetes.

DESIGN

Retrospective review of medical records.

SETTING

Department of medicine at our institution.

PATIENTS AND METHODS

This retrospective observational study evaluated patients receiving the glucagon-like peptide-1 analog semaglutide, with the trade name Ozempic. The weight, height, body mass index, blood pressure, and laboratory data, including serum creatinine and hemoglobin A1c (HbA1c) levels and urine albumin/creatinine ratio, were recorded. Moreover, any history of medical comorbidities, such as cardiovascular diseases, cerebrovascular diseases, and heart failure, was documented before and after drug administration.

MAIN OUTCOME MEASURES

Glycemic and weight loss efficacy.

SAMPLE SIZE

1007 patients.

RESULTS

The median age of the patients was 57.0 years, comprising 60.28% females. Among them, 955 and 442 patients received the medication for at least 3 and 6 months, respectively. Our results show a 4.4% weight loss and 0.4% improvement in HBA1c in patients with diabetes. Similar results were observed in the patients without diabetes in terms of weight along with a significant decrease in diastolic blood pressure. Our results also show stability in the serum creatinine and urine albumin creatinine ratio. The drug was equally effective in males and females.

CONCLUSION

Treatment with once-weekly subcutaneous semaglutide (1 mg) led to clinically significant weight loss and improved HbA1c level and cardiometabolic risk factors such as blood pressure.

LIMITATIONS

Retrospective design.

Long-term safety and efficacy of glucagon-like peptide-1 receptor agonists in individuals with obesity and without type 2 diabetes: A global retrospective cohort study

AIM

We aimed to investigate the long-term impact of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) on thyroid function, cardiovascular health, renal outcomes and adverse events in individuals with obesity and without type 2 diabetes (T2D).

MATERIALS AND METHODS

In this observational cohort study, we used propensity score matching to construct comparable cohorts of individuals with obesity and without T2D who were new to GLP-1 RA treatment and those who did not receive glucose-lowering medications. In total, 3,729,925 individuals with obesity were selected from the TriNetX Global Network, with an index event between 1 January 2016 and 31 March 2024. The primary outcomes were safety, cardiovascular, thyroid and clinical biochemical profile outcomes occurring within 5 years following the index event.

RESULTS

After propensity score matching, the study included 12,123 individuals in each group. GLP-1 RA treatment was associated with a significantly lower risk of all-cause mortality (hazard ratio 0.23; 95% confidence interval 0.15-0.34) and several cardiovascular complications, including ischaemic heart disease, heart failure, arrhythmias, hypertension, stroke and atrial fibrillation (all p < 0.05). GLP-1 RAs were also associated with a lower risk of acute kidney injury and allergic reactions. These protective effects were consistent across various subgroups and regions.

CONCLUSIONS

In this large observational study, GLP-1 RAs showed long-term protective effects on cardiovascular health, renal outcomes and adverse events in individuals with obesity and without T2D. Our findings suggest that GLP-1 RAs may offer a comprehensive approach to managing obesity and its related comorbidities, potentially improving overall health and survival in this population.

The Effect of Lifestyle Coaching Design on Patient Engagement and Weight Loss in Non-diabetic Patients of a Semaglutide-Supported Digital Obesity Program in the UK: A Comparative Retrospective Cohort Study

Digital weight-loss services (DWLSs) that supplement continuous lifestyle coaching with semaglutide therapy have shown promise in delivering continuous and effective obesity care. However, the extent to which lifestyle coaching design influences patient engagement and program effectiveness is unknown. This study retrospectively analysed several engagement markers and weight loss percentage over 16 weeks in a large semaglutide-supported DWLS in the UK (n=154). The comparative analysis found that patients who received lifestyle coaching that was proactive and personalised sent a statistically higher number of messages to their health coach (Mean=19.37 vs Mean=8.55) and opened the program app more frequently (Mean = 49.31 days vs Mean = 40.06 days) than patients whose coaching was reactive and standardised. Mean 16-week weight loss was 10.1% in the proactive group compared to 8.9% in the reactive group, but the difference was not statistically significant. A two-sample t-test found that female patients (Mean = 9.76%) tended to lose more weight than male patients (Mean = 6.88%), (t(152) = 1.89, p = 0.04). The findings add vital layers of nuance to the emerging literature on semaglutide-supported DWLSs, indicating that a proactive, personalised coaching approach leads to better patient engagement, but that such engagement is not correlated with better short-term weight-loss or program adherence outcomes. Moreover, the cohort's comparably higher mean weight loss relative to previous real-world semaglutide studies lend support to the advice of leading global health institutions of using the medication only as an adjunct to multidisciplinary lifestyle therapy. Investigators should expand on this research by conducting comparable studies over a longer period and with medication-only control groups.

Estimating the lives that could be saved by expanded access to weight-loss drugs

Obesity is a major public health crisis in the United States (US) affecting 42% of the population, exacerbating a spectrum of other diseases and contributing significantly to morbidity and mortality overall. Recent advances in pharmaceutical interventions, particularly glucagon-like peptide-1 (GLP-1) receptor agonists (e.g., semaglutide, liraglutide) and dual gastric inhibitory polypeptide and GLP-1 receptor agonists (e.g., tirzepatide), have shown remarkable efficacy in weight-loss. However, limited access to these medications due to high costs and insurance coverage issues restricts their utility in mitigating the obesity epidemic. We quantify the annual mortality burden directly attributable to limited access to these medications in the US. By integrating hazard ratios of mortality across body mass index categories with current obesity prevalence data, combined with healthcare access, willingness to take the medication, and observed adherence to and efficacy of the medications, we estimate the impact of making these medications accessible to all those eligible. Specifically, we project that with expanded access, over 42,000 deaths could be averted annually, including more than 11,000 deaths among people with type 2 diabetes. These findings underscore the urgent need to address barriers to access and highlight the transformative public health impact that could be achieved by expanding access to these novel treatments.

Semaglutide treatment of hypothalamic obesity - a real-life data study

PURPOSE

Patients with tumors involving the hypothalamic region are at high risk of developing morbid obesity due to disturbances in the appetite regulative nuclei in hypothalamus. We evaluated the effect of the Glucagon-like peptide 1 (GLP-1) analogue semaglutide in patients with hypothalamic obesity.

METHODS

We recorded weight changes from real-time data before and after treatment with semaglutide in patients with hypothalamic obesity from our outpatient clinic at the Department of Endocrinology at Rigshospitalet, from September 2020 to November 2023.

RESULTS

A total of 26 patients were included in this study (15 females, median age at initiation of semaglutide was 52 (range 18-65) years). Body mass index (BMI) at initial diagnosis was median 25 (range 20-38) kg/m2 while BMI at initiation of semaglutide was median 38 (range 28-58) kg/m2. All but one patient lost weight during semaglutide treatment with a mean weight loss of 13.4 kg (95% CI 10.3-16.5 kg, p = < 0.001) after 12 months corresponding to a loss in BMI of 4.4 kg/m2 (95% CI 3.4-5.4 kg/m2, p = < 0.001) with a median dosage of semaglutide of 1.6 (range 0.5-2.5) mg. Fifteen patients (58%) lost more than 10% and two patients (8%) lost more than 20% of initial body weight, respectively.

CONCLUSION

Treatment with semaglutide shows promising results in reducing body weight in patients with acquired hypothalamic obesity. Whether the weight reduction remains stable after long time follow-up needs further investigation.

Multimodal approach utilising a weight management programme prior to bariatric surgery in patients with BMI ≥50 kg/m2: A propensity score matching retrospective cohort study

We evaluated preoperative weight loss and days from initial consult to surgery in patients with BMI ≥50 kg/m2 who were and were not enrolled in medical weight management (MWM) prior to laparoscopic sleeve gastrectomy. We retrospectively identified patients with BMI ≥50 kg/m2 who had primary sleeve gastrectomy between 2014 and 2019 at two bariatric surgery centres in our healthcare system. Patients presenting after 2017 that received preoperative MWM (n = 28) were compared to a historical cohort of non-MWM patients (n = 118) presenting prior to programme initiation in 2017 on preoperative percent total body weight loss (%TBWL) and days from initial consult to surgery. A total of 151 patients (MWM, 33; non-MWM, 118) met inclusion criteria. BMI was significantly greater in MWM versus non-MWM (p = .018). After propensity score matching, median BMI at initial consult in non-MWM versus MWM no longer differed (p = .922) neither were differences observed on the basis of weight, age, sex, race or ethnicity. After PSM, MWM had significantly lower BMI at surgery (p = .018), lost significantly more weight from consult to surgery (p < .001) and achieved significantly greater median %TBWL from consult to surgery (p < .001). We noted no difference between groups on 6-month weight loss (p = .533). Days from initial consult to surgery did not differ between groups (p < .863). A preoperative MWM programme integrated into multimodal treatment for obesity in patients with a BMI ≥50 kg/m2 resulted in clinically significant weight loss without prolonging time to surgery.

Yoyo Dieting, Post-Obesity Weight Loss, and Their Relationship with Gut Health

Excessive body weight is associated with many chronic metabolic diseases and weight loss, so far, remains the gold standard treatment. However, despite tremendous efforts exploring optimal treatments for obesity, many individuals find losing weight and maintaining a healthy body weight difficult. Weight loss is often not sustainable resulting in weight regain and subsequent efforts to lose weight. This cyclic pattern of weight loss and regain is termed "yoyo dieting" and predisposes individuals to obesity and metabolic comorbidities. How yoyo dieting might worsen obesity complications during the weight recurrence phase remains unclear. In particular, there is limited data on the role of the gut microbiome in yoyo dieting. Gut health distress, especially gut inflammation and microbiome perturbation, is strongly associated with metabolic dysfunction and disturbance of energy homeostasis in obesity. In this review, we summarise current evidence of the crosstalk between the gastrointestinal system and energy balance, and the effects of yoyo dieting on gut inflammation and gut microbiota reshaping. Finally, we focus on the potential effects of post-dieting weight loss in improving gut health and identify current knowledge gaps within the field, including gut-derived peptide hormones and their potential suitability as targets to combat weight regain, and how yoyo dieting and associated changes in the microbiome affect the gut barrier and the enteric nervous system, which largely remain to be determined.

One-Year Weight Reduction With Semaglutide or Liraglutide in Clinical Practice

Importance

Limited data are available on long-term weight loss achieved with semaglutide or liraglutide for type 2 diabetes (T2D) or obesity in clinical practice.

Objective

To document weight loss achieved with injectable forms of semaglutide or liraglutide and identify factors associated with weight reduction of 10% or greater at 1 year.

Design, Setting, and Participants

This retrospective cohort study used electronic health records from a large, integrated health system in Ohio and Florida. Participants included adults with a body mass index (calculated as the weight in kilograms divided by the height in meters squared) of at least 30.0 who initiated treatment with semaglutide or liraglutide between July 1, 2015, and June 30, 2022. Follow-up was completed July 28, 2023.

Exposure

Injectable forms of semaglutide or liraglutide approved for T2D or obesity.

Main Outcomes and Measures

Percentage weight change and categorical weight reduction of 10% or greater at 1 year.

Results

A total of 3389 patients (mean [SD] age, 50.4 [12.2] years; 1835 [54.7%] female) were identified. Of these, 1341 patients received semaglutide for T2D; 1444, liraglutide for T2D; 227, liraglutide for obesity; and 377, semaglutide for obesity. Mean (SD) percentage weight change at 1 year was -5.1% (7.8%) with semaglutide vs -2.2% (6.4%) with liraglutide (P < .001); -3.2% (6.8%) for T2D as a treatment indication vs -5.9% (9.0%) for obesity (P < .001); and -5.5% (7.5%) with persistent medication coverage (ie, a cumulative gap of less than 90 days) at 1 year vs -2.8% (7.0%) with 90 to 275 medication coverage days and -1.8% (6.7%) with fewer than 90 medication coverage days (P < .001). In the multivariable model, semaglutide vs liraglutide (adjusted odds ratio [AOR], 2.19 [95% CI, 1.77-2.72]), obesity as a treatment indication vs T2D (AOR, 2.46 [95% CI, 1.83-3.30]), persistent medication coverage vs 90 medication coverage days (AOR, 3.36 [95% CI, 2.52-4.54]) or 90 to 275 medication coverage days within the first year (AOR, 1.50 [95% CI, 1.10-2.06]), high dosage of the medication vs low (AOR, 1.58 [95% CI, 1.11-2.25]), and female sex (AOR, 1.57 [95% CI, 1.27-1.94]) were associated with achieving a 10% or greater weight reduction at year 1.

Conclusions and Relevance

In this retrospective cohort study of 3389 patients with obesity, weight reduction at 1 year was associated with the medication's active agent, its dosage, treatment indication, persistent medication coverage, and patient sex. Future research should focus on identifying the reasons for discontinuation of medication use and interventions aimed at improving long-term persistent coverage.

Outcomes of concomitant antiobesity medication use with endoscopic sleeve gastroplasty in clinical US settings

Background

To evaluate the weight loss outcomes of the large US cohort of patients undergoing endoscopic sleeve gastroplasty (ESG) with or without concomitant anti-obesity (AOM) use.

Methods

We performed a retrospective analysis of adult patients who underwent ESG from seven different sites, from January 1, 2020 to November 30, 2022. Percent total body weight loss (%TBWL) and %excess weight loss (%EWL) were calculated based on baseline weight at the procedure. Medication use was considered if the subject received a prescribed AOM during the study period. SPSS (version 29.0) was used for statistical analyses.

Results

A total of 1506 patients were included (1359 (90.2 %) no AOM use and 147 (9.8 %) AOM use). Patients who were on an active AOM at the time of the procedure had a significantly lower TBWL% as compared to patients not on AOMs at 6 months. At the 24-month visit, patients who were prescribed AOMs after the 12-month visit had a significantly higher TBWL% and EWL% as compared to patients who were on active AOM at the time of the procedure. There was no significant difference between classes of medications at any time point, however, patients on a GLP-1RA had a trend towards improved weight loss at 18 and 24 months.

Conclusion

In this large, real-world cohort of patients from the United States, data signal that with the use of pharmacotherapy at the appropriate time, patients can achieve optimal results.

Efficacy of Different Doses and Forms of the GLP-1 Receptor Agonist Semaglutide in Weight Reduction Among Non-diabetic Obese or Overweight Populations

Disorders linked to increased body weight are on the rise and obesity is a global epidemic associated with a rising risk for developing comorbidities, such as hypertension or type 2 diabetes. There is a significant need to develop a multimodal approach targeting obesity within clinical medicine. Pharmacological options to produce weight loss have been a popular research area and the novel glucagon-like Peptide-1 receptor agonists (GLP-1 RA) are highly effective glycemic control agents that have shown a substantial weight loss effect. This systematic review explores the efficacy of semaglutide, a GLP-1 RA agent, in a non-diabetic population, looking at endpoints of changes in weight and waist circumference and the percentage of patients achieving a clinically effective weight loss of at least 5%. This study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. A comprehensive search was undertaken to find applicable papers using three databases, including PubMed, PubMed Central, and Cochrane Library. The included articles were narrowed down from an initial pool of 423 papers using filters, automation tools, inclusion/exclusion criteria, and quality appraisal tools. In this systematic review, we have analyzed 10 high-quality studies published in the last five years, including nine randomized control trials (RCTs) and a retrospective cohort study. The aim was to combine the results of these studies, encompassing 6623 participants, to showcase the effectiveness of GLP-1 RAs in the non-diabetic obese or overweight population. The consolidated data from the literature in this systematic review endorses the use of semaglutide as a highly efficient weight-reducing agent, contributing positive insight to both clinicians and researchers in the field of obesity treatment.

Cardiovascular Protective Properties of GLP-1 Receptor Agonists: More than Just Diabetic and Weight Loss Drugs

Owing to their potent glucose-lowering efficacy and substantial weight loss effects, glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are now considered part of the frontline therapeutic options to treat both type 2 diabetes mellitus and nondiabetic overweight/obesity. Stemming from successful demonstration of their cardiometabolic modulation and reduction of major adverse cardiovascular events in clinical outcome trials, GLP-1 RAs have since been validated as agents with compelling cardiovascular protective properties. Studies spanning from the bench to preclinical and large-scale randomised controlled trials have consistently corroborated the cardiovascular benefits of this pharmacological class. Most notably, there is converging evidence that they exert favourable effects on atherosclerotic ischaemic endpoints, with preclinical data indicating that they may do so by directly modifying the burden and composition of atherosclerotic plaques. This narrative review examines the underlying pharmacology and clinical evidence behind the cardiovascular benefits of GLP-1 RAs, with particular focus on atherosclerotic cardiovascular disease. It also delves into the mechanisms that underpin their putative plaque-modifying actions, addresses existing knowledge gaps and therapeutic challenges and looks to future developments in the field, including the use of combination incretin agents for diabetes and weight loss management.

Efficacy of Antiobesity Medications in Patients With Celiac Disease on a Gluten-free Diet: A Retrospective Matched Cohort Study

GOALS

We aim to describe the weight loss outcomes of patients with celiac disease (CeD) taking antiobesity medications (AOMs) and compare it with the weight loss outcomes of patients without CeD taking AOMs.

BACKGROUND

Increasing rates of obesity and obesity-associated comorbidities have been previously reported in patients with CeD on a gluten-free diet. The effectiveness of AOMs in this population has not been previously described.

METHODS

In our retrospective cohort study, we matched 39 patients with treated CeD to 78 patients without CeD based on sex and AOM. We assessed the weight loss outcomes at 3, 6, and 12 months after starting the AOM in both cohorts and analyzed if there was a differential response when comparing by type of AOM [injectable glucagon-like peptide 1 (GLP-1) receptor agonists vs. oral non-GLP-1 AOMs].

RESULTS

Both cohorts had similar baseline demographic and anthropometric characteristics. At 12 months, the CeD cohort had a nonsignificantly inferior total body weight loss percentage compared with the cohort without CeD (6.5% vs. 9.5%, P =0.13). The CeD cohort had a similar proportion of patients achieving a total body weight loss percentage of ≥5% than the cohort without CeD (72.7% vs. 72.1%, P =1.00). No significant difference was observed when comparing the weight loss outcomes of injectables (GLP-1 receptor agonists) to oral AOMs. The proportion of patients reporting side effects was similar for both groups, regardless of the type of AOM.

CONCLUSION

Patients with CeD taking AOMs had similar weight loss outcomes to patients without CeD. Hence, AOMs can be a safe and effective therapy for weight management in patients with CeD.

Effect of Semaglutide in Individuals With Obesity or Overweight Without Diabetes

This systematic review evaluates the efficacy and safety of semaglutide in individuals with obesity or overweight without diabetes. Obesity is a significant public health concern, associated with various comorbidities and reduced quality of life. Semaglutide, a glucagon-like peptide-1 receptor agonist, has emerged as a promising pharmacological intervention for weight management. This review synthesizes findings from multiple clinical trials, highlighting the impact of semaglutide on weight loss, metabolic parameters, and overall health outcomes in non-diabetic populations. The review also addresses methodological considerations, including study design, participant selection, and outcome measures, to assess the robustness of the evidence. Ethical considerations and potential conflicts of interest are discussed to ensure transparency in the research process. The findings indicate that semaglutide is associated with significant weight reduction and improvement in obesity-related health markers, suggesting its potential as a valuable treatment option for individuals struggling with obesity. Limitations of the current literature and recommendations for future research directions are also presented, emphasizing the need for further studies to explore the long-term effects and generalizability of semaglutide treatment in diverse populations.

Implementation of Obesity Science Into Clinical Practice: A Scientific Statement From the American Heart Association

Obesity is a recognized public health epidemic with a prevalence that continues to increase dramatically in nearly all populations, impeding progress in reducing incidence rates of cardiovascular disease. Over the past decade, obesity science has evolved to improve knowledge of its multifactorial causes, identifying important biological causes and sociological determinants of obesity. Treatments for obesity have also continued to develop, with more evidence-based programs for lifestyle modification, new pharmacotherapies, and robust data to support bariatric surgery. Despite these advancements, there continues to be a substantial gap between the scientific evidence and the implementation of research into clinical practice for effective obesity management. Addressing barriers to obesity science implementation requires adopting feasible methodologies and targeting multiple levels (eg, clinician, community, system, policy) to facilitate the delivery of obesity-targeted therapies and maximize the effectiveness of guideline-driven care to at-need patient populations. This scientific statement (1) describes strategies shown to be effective or promising for enhancing translation and clinical application of obesity-based research; (2) identifies key gaps in the implementation of obesity science into clinical practice; and (3) provides guidance and resources for health care professionals, health care systems, and other stakeholders to promote broader implementation and uptake of obesity science for improved population-level obesity management. In addition, advances in implementation science that hold promise to bridge the know-do gap in obesity prevention and treatment are discussed. Last, this scientific statement highlights implications for health research policy and future research to improve patient care models and optimize the delivery and sustainability of equitable obesity-related care.

Efficacy of Glucagon-Like Peptide 1 (GLP-1) Receptor Agonists for Weight Loss Management in Non-Diabetic Patients

The rising prevalence of obesity has led to a poor quality of life affecting millions worldwide. The lack of a healthy diet and exercise intervention are the major risk factors leading to obesity, as well as genetics. Obesity can lead to type 2 diabetes mellitus. However, there are many people who are obese and do not have an established diagnosis of diabetes but want to reduce their body weight to improve their quality of life. This review aims to discuss the efficacy of the diabetic pharmacologic agents, glucagon-like peptide-1 (GLP-1) receptor agonists, on body weight. The review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines 2020 and includes a comprehensive search strategy. The articles gathered are from the last five to 10 years. The articles are collected from distinguished databases such as PubMed, Google Scholar, ResearchGate, and Science Direct. Of the 698 studies identified based on the screening methods, 22 were assessed for eligibility and 10 studies were included in the final review. The findings of this systematic review provide a bigger picture of the efficacy and safety of glucagon-like peptide receptor agonist agents. The review thoroughly discusses the risk factors for obesity and provides a treatment strategy that can be utilized in clinical practice in the future. The review concludes that glucagon-like peptide agents act as pharmacologic treatments for reduction in body weight and also serve as cardioprotective agents.

The impact of obesity on postoperative outcomes following surgery for colorectal cancer: analysis of the National Inpatient Sample 2015-2019

BACKGROUND

The global burden of obesity has reached epidemic proportions, placing great strain on the North American healthcare system. We designed a retrospective cohort database study comparing postoperative morbidity and healthcare resource utilization between patients living with and without obesity undergoing surgery for colorectal cancer.

METHODS

Adult patients undergoing resection for colorectal cancer were identified from the 2015 to 2019 National Inpatient Sample database. Patients were stratified according to obesity status (i.e., body mass index of 30 kg/m2). Propensity score matching (PSM) with 1:1 nearest-neighbour matching was performed according to demographic, operative, and hospital characteristics. The primary outcome was postoperative morbidity. Secondary outcomes included system-specific postoperative complications, postoperative mortality, length of stay, total admission healthcare cost, and post-discharge disposition. McNemar's and Wilcoxon matched pairs signed rank tests were performed.

RESULTS

After PSM, 7565 non-obese and 7565 obese patients were included. Patients with obesity had a 10% increase in relative risk of overall in-hospital postoperative morbidity (23.1% versus 25.6%, P = 0.0015) and a $4564 increase in hospitalization cost ($70 248 USD versus $74 812 USD, P = 0.0004). Patients with obesity were more likely to require post-operative ICU admission (5.0% versus 8.0%, P < 0.0001) and less likely to be discharged home after their index operation (68.3% versus 64.2%, P = 0.0022).

CONCLUSION

Patients with obesity undergoing surgery for colorectal cancer may be at an increased risk of in-hospital postoperative morbidity. They may also be more likely to have increased hospitalization costs, post-operative ICU admissions, and to not be discharged directly home. Preoperative optimization via weight loss strategies should be further explored.

Key messages on obesity care from the 2023 ASPEN Physician Preconference Course: A narrative review

Obesity is a challenging chronic disease process that continues to affect a large percentage of the population at large. With the advent of new therapeutic options and interventions and a deeper scientific understanding of obesity as a complex illness, there is hope in curtailing this evolving pandemic. In this article, we present key medical information to engage and empower nutrition-focused providers to manage obesity and its nutrition complications. The topics summarized here were presented during the 2023 American Society for Parenteral and Enteral Nutrition Preconference Physician Course and include pathophysiology and hormonal regulation of obesity, multidisciplinary care planning and nutrition risk stratification of patients, and common approaches to treatment, including lifestyle modifications, antiobesity medications, and procedures from the perspective of the nutrition specialist.