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

📖 Top 20% JournalJan 17, 2025BMJ open

Factors linked to weight loss results from GLP-1 medicines for obesity

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Abstract

The average total body weight loss (TBWL) among 483 adults receiving GLP-1 analogue therapy was 12.2% after a mean follow-up of 17.3 months.

17.8% of participants were classified as non-responders, with less than 5% TBWL.
48.4% experienced a moderate response, achieving between 5% and 15% TBWL.
33.8% had a hyper-response, losing more than 15% of their body weight.
Being a woman was associated with a higher likelihood of hyper-response to GLP-1 analogue therapy.
No independent associations were found between TBWL and factors such as age, diabetes status, baseline BMI, sedentary lifestyle, anxiety, or depression.

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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/mwho 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. 2

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.

Key numbers

12.2%

Average Total Body Weight Loss

Average weight loss across all participants receiving GLP-1 therapy.

33.8%

Hyper-responders Proportion

Percentage of participants achieving >15% total body weight loss.

1.92

Adjusted Odds Ratio for Women

Odds ratio comparing hyper-response in women vs. non-responders.

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Abstract

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