麻豆传媒

This article is a collaboration between 麻豆传媒 and:

NASHVILLE -- Liraglutide (Victoza, Saxenda) added to intensive behavioral therapy (IBT) yielded significant weight loss for patients with obesity, researchers said.

Compared with IBT alone, adults who received 3 mg of the GLP-1 receptor liraglutide as part of their treatment saw significantly greater weight loss after 1 year, reported Thomas Wadden, PhD, of the Perelman School of Medicine at the University of Pennsylvania (UPenn) in Philadelphia, and colleagues in .

A companion was presented here at ObesityWeek, the joint annual meeting of The Obesity Society and the American Society for Metabolic & Bariatric Surgery.

Patients who received IBT plus liraglutide in addition to a daily meal replacement diet saw only slightly greater extents of weight lost compared with IBT and liraglutide alone:

• IBT alone: lost 6.1 ± 1.3% of baseline weight
• IBT plus liraglutide: 11.5 ± 1.3%
• IBT, liraglutide, plus meal replacement: 11.8 ± 1.3%

Similar patterns were seen after 1 year in individuals who successfully lost ≥5% of their baseline body weight:

• IBT alone: 44% achieved
• IBT plus liraglutide: 70%
• IBT liraglutide, plus meal replacement: 74%

Finding out that the meal replacement group did not see significantly greater weight loss compared with the IBT and liraglutide group who ate conventional foods came as a surprise, Wadden told 麻豆传媒.

"In a prior study that combined group treatment, the weight loss medication sibutramine, and meal replacements, we found that the addition of meal replacements increased weight loss by about 5 percentage points, compared with the consumption of a conventional diet of 1,200-1,500 kcal, combined with the same program of group treatment and sibutramine. Participants in our present study, who received individual rather than group counseling, did not appear to adhere to the meal replacements as well as participants who had group support and perhaps a dose of group competition," he said.

Still, all groups saw clinically meaningful improvements in many cardiovascular risk factors associated with their weight loss, such as systolic and diastolic blood pressure, waist circumference, and triglycerides that were expected, Wadden stated.

The 52-week randomized, controlled trial included 150 adults with obesity (BMI 30-55) evenly assigned to one of the three interventions. IBT was delivered over the course of 21 sessions as recommended by the Centers for Medicare & Medicaid Services, which provides coverage for this type of obesity treatment.

All participants were required to have tried to lose weight with diet and physical activity before being considered for the study. Participants who weighed <250 lbs were told to adhere to a 1,200-1,499 kcal/day diet of conventional foods, while those >250 lbs had a 1,500-1,800 kcal/day diet. These diets were comprised of 20% protein, 20%-35% fat, and 45%-60% carbohydrate.

Injectable liraglutide was self-administered once daily. Those receiving the meal replacement intervention were given a 1,000-1,200 kcal/day diet comprised of four servings of liquid shakes plus one 250-300 kcal frozen dinner for 12 weeks.

In order to delve deeper into the specific effects of liraglutide on appetite, the researchers conducted a substudy of 113 trial participants. Led by Jena Shaw Tronieri, PhD, also of UPenn, they reported that after 6 weeks of active interventions, adults who were receiving liraglutide self-reported significant changes in appetite and satiety compared with patients not on liraglutide:

• Reductions in hunger: -0.3±4.2 for IBT only versus -16.8±4.0 mm for IBT + liraglutide (P=0.005)
• Reductions in food preoccupation: +0.2±3.7 versus -16.3±3.6 mm (P=0.002)
• Increases in fullness: -5.1±3.2 versus +9.8±3.0 mm (P=0.001)

Ratings were based on changes from baseline and eight additional follow-up visits through the year, based on a 100-point visual analogue scale. However, liraglutide didn't effect feelings of meal liking. Also, while these differences were maintained 24 weeks into treatment, they were not maintained through the end of the 52-week trial.

Based on their clinical experiences, Wadden and Shaw Tronieri suggested that medication-assisted treatment may have a place for patients not able to lose weight with behavioral therapies or who report feeling hungry much of the time, even after eating.