An integrated approach for obesity management: the effectiveness of glucagon-like peptide 1 agonist and life-style interventions for obesity management

Abstract

Background. The obesity is found in 24.8% (approximately 10 million people) and overweight in 34.3% of the population of Ukraine, mainly in females. Obesity is associated with hereditary factors, overeating as well as a sedentary lifestyle. An integrated approach is applied to treat obesity such as combination of adequate eating behavior, high physical activity and administration of pharmacological correction, including glucagon-like peptide 1 agonist (GLP-1). Currently, the little is known about utility and effectiveness of GLP-1 in combination with adequate physical activity for obesity management among Ukrainian patients. The purpose of this study was to determine and evaluate the role of GLP-1 in combination with high physical activity for weight loss in obese patients and to compare with obese patients receiving treatment with metformin and sodium-glucose cotransporter 2 inhibitors (SGLT2i). Materials and methods. A prospective study included 155 obese patients, and follow-up data were available of 49 patients. The study group GLP-1 consisted of 30 patients receiving combination therapy GLP-1 liraglutide in daily doses of 1.2 to 3 mg per day. The control group consisted of 19 patients receiving complex therapy with metformin in daily doses from 500 to 2000 mg, and SGLT2i in daily doses from 10 to 12.5mg. Body mass index (BMI), waist circumference (WC), hip circumference (HC), and WC/HC ratio were evaluated. Number of daily steps was determined using pedometers built into smartphones or smartwatches. Evaluation of the obtained data was performed using non-parametric statistical methods. Results. In study group GLP-1 the mean weight before the treatment was 104.6kg, after treatment 96.36 kg (p=0.000007), the mean weight lost was 7.8% (range 1–23.71%) of initial body weight. Mean BMI before treatment was 37.1 kg/m2, after treatment 34.11kg/m2 (p=0.000006). In the control group, the mean weight before the treatment was 99.4 kg, after treatment 91.74 kg (p=0.000196), the mean weight lost was 7.73% (range 0–16.9%) of initial body weight. Mean BMI before treatment was 35.6kg/m2, after treatment 34.11 kg/m2 (p=0.000196). Analyses of the entrie chorot showed that before treatment, the daily number of steps >5000/day was determined in 25 (51%) patients, after treatment in 48 (98%); the daily number of steps >10,000/day before treatment was determined in 6 (11%) patients, after treatment it was 5 times more frequent in 31 (63%) patients. These results indicate a significant intensification of physical activity, and high motivation for weight loss in both study groups. Conclusions. Our findings suggest that weight loss in obese people is effective in case of administration of GLP-1, metformin, SGLT2i in combination with high physical activities of daily steps >5000, which is part of life style intervention.