Can we use calorie intake and food choice measurements to determine individual variation in weight loss success to liraglutide 3.0 mg A direct method of eating behaviour assessment

BACKGROUND: Obesity is a major global health concern. Weight loss interventions are plentiful, but sustainable long‐term weight loss is challenging. Patients who fail to reach the planned weight loss targets or regain their weight are often accused of their lack of dietary or pharmacological compliance or loss of will power. We need to have a better understanding of the individual variation in responding to different treatments including lifestyle programmes and liraglutide 3.0 mg to develop a personalized care and achieve better results. In this study, we aimed to assess calorie intake and food choices as potential factors contributing to treatment success. METHODS: Patients were randomized 2:1 to receive liraglutide 3.0 mg plus a standard lifestyle programme (LIRA n = 32) or a standard lifestyle programme alone (STD n = 10). Patients in the LIRA arm were further divided to responders (LIRA R) or non‐responders (LIRA NR) based on a predetermined weight loss target (achievement of ≥10% at 7‐month postmedication initiation). The LIRA NRs were discontinued from receiving lira 3.0 mg but continued to receive the standard lifestyle programme. All patients completed a standardized buffet meal where calorie intake and macronutrients breakdown were assessed. Participants attended at baseline 4 and 12 months after intervention. RESULTS: The successful response rate to liraglutide 3.0 mg was 75%. At 12 months, on average, LIRA R lost 13% of their baseline weight. On the other hand, the LIRA NR had regained all of the weight they had lost earlier in the trial and were 1.4% heavier at 12 months. The STD group had maintained 1.6% weight loss at 12 months. The total calories intake in the LIRA R decreased by 401 kcal at 4 months (p = 0.001) and 96 kcal at 12 months (p = ns), as compared to baseline. In the LIRA NR, there was only a 49‐ and 201‐kcal reduction at 4 and 12 months (p = ns), respectively. The STD group had a 368‐kcal reduction at 4 months (p = 0.02) and 546 kcal at 12 months (p = ns). There was no change in absolute macronutrient intake compared to baseline levels in any of the groups. Neither calorie intake nor macronutrient composition successfully predicted or associated with weight loss success. However, weight loss at 4 months was a successful predictor of weight loss at 1 year for all groups (p = 0.006 LIRA R; p = 0.01 LIRA NR; and p = 0.006 STD). CONCLUSION: Liraglutide combined with a standard lifestyle programme is more effective than a standard lifestyle programme alone for weight loss. Nevertheless, not all patients will respond to this treatment equally, and individual variation should be taken into consideration when prescribing the drug. Early weight loss response is the best predictor for longer term success, and healthcare professionals can use it as a tool to discuss treatment goals and options with their patients.