Outcomes of obesity medications in those with low response to a low-energy diet meal replacement programme: An observational study

TL;DR

The study found that people who didn't lose much weight on a meal replacement diet didn't respond well to obesity medications like liraglutide or naltrexone/bupropion.

Contribution

This is the first study to evaluate obesity medication outcomes in individuals with low response to a structured meal replacement program.

Findings

Only 24% of completers achieved ≥5% weight reduction after 13 weeks of medication.

Mean weight change among completers was −4.4 kg (−2.4%), and −2.7 kg (−1.5%) for the total treated cohort.

Those achieving ≥5% weight reduction were more likely to be male and had fewer baseline mental health or eating issues.

Abstract

It is not known how individuals respond to liraglutide or naltrexone/bupropion following low-response to a structured meal replacement low energy diet (MR-LED) programme.

This was a retrospective observational study conducted at a specialist weight management service using MR-LED with intensive behavioural therapy (IBT). Adults were considered for obesity medication if they did not lose at least 5 % body weight in the first 4 weeks of the intensive MR phase, 10 % after the total 12 week MR phase or regained >4 kg either during the stepped food reintroduction or weight maintenance phases. Eligible individuals were offered liraglutide 3.0 mg (LIRA) or naltrexone/bupropion (NB32) for 13 weeks (including dose titration). The primary outcome was the proportion of individuals achieving ≥5 % weight reduction after 13 weeks of treatment. Completers were defined as those who had a body weight measured between 10 and 16 weeks and did not discontinue the medication before this period.

Of 114 people offered obesity medications, 85 accepted (67 LIRA, 18 NB32). 46 individuals completed 13 weeks’ treatment and 11 (24 %) achieved ≥5 % weight reduction. Among completers (54 %), the mean weight change was −4.4 kg (−2.4 %), and was −2.7 kg (−1.5 %) for the total treated cohort using last weight carried forward on missing data. Those achieving ≥5 % weight reduction were more likely to be male and had lower prevalence of diabetes, binge eating, anxiety or depressive symptoms at baseline.

People who do not respond to a MR-LED with IBT have lower than anticipated weight reduction on subsequent treatment with first-generation obesity medications.

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