No abstract

Obesity treatment requires a chronic state of negative energy balance. Obesity medications can help with this, increasing long-term dietary compliance by promoting satiety or reducing hunger. However, efficacy and safety of obesity medications vary for individuals. Early identification of non-responders to obesity medications may limit drug exposure while optimizing benefits for responders. This review summarizes factors that impact weight-loss response to liraglutide. Factors linked to greater weight loss on liraglutide include being female, not having diabetes, having relatively high baseline weight, and losing at least 4% of initial weight after 16 weeks of treatment. Other covariates that may predict treatment response but require further confirmation include central effects, nausea, gastric emptying of solids, and genotype. Baseline body mass index, race, and age seem less relevant for predicting weight-loss response to liraglutide.Lesser known and harder-to-measure factors such as cerebral blood flow, food cue reactivity, gut hormone levels, and dietary adherence possibly impact variability of response to liraglutide. This information should assist healthcare providers with establishing realistic weight-loss probability for individual patients. Future research should improve the ability to identify responders to liraglutide. Importantly, this review may provide a framework to identify responders to other obesity medications.

Objectives Lifestyle modification treatment (LMT) forms the essential basis of weight loss approaches for obesity management. However, key studies that used LMT report variable weight loss success, ranging from poor response (1–2%) to substantial weight loss (7–10%). Although the components of LMT varied in these studies, overall, the better weight loss outcomes appear to be linked to highly involved and customized LMT. Conversely, a generic intervention and limited engagement seem linked to poorer weight los outcomes, which may undermine the true potential of LMT. Here, we detail a modified-LMT (CAP-LMT) which we have used for 15,000 individuals, and that reported 9.75% weight loss in completers of a 15-wk program for 1117 patients (Dhurandhar & Kulkarni. Int J Food Sci Nutr 1993:44(2), 73–83). Methods The CAP-LMT is a structured approach that is: Compatibility-based: Often, LMT emphasizes behaviors that are ideal from a scientific perspective to which a person is expected to conform. Instead, considering that the compliance and sustainability of a treatment guides the outcome, a treatment is needed that suits an individual. This is achieved by a thorough assessment of an individual's physical and mental health, lifestyle, dietary and other preferences, allergies, culture, and social and economic status. Allocation-focused: Often dietary instructions in LMT provide a generic list of “good” and “bad” foods without quantitative guidance. To effectively create a negative energy balance, an understanding of a person's calorie needs, targeted energy deficit, and guidance for the amounts of specific foods to eat is needed. Suggestions for physical activity and other lifestyle changes should be based on personal attitudes, preferences, and health conditions. Progress monitoring: Weight-loss treatment should not end with providing one-time instructions for diet and activity. Careful follow-up to assess progress and course correction is needed based on the individual's response. Also, a change in recommended diet plans at appropriate intervals avoids monotony and increases compliance. Results n/a. Conclusions The presentation will outline a stepwise approach to construct a comprehensive, highly individualized plan for greater compliance and better weight loss outcomes in research and clinical practice settings. Funding Sources None.