A new study provides evidence that treatment with semaglutide, in combination with lifestyle interventions, can lead to significant weight loss and improvements in abnormal eating patterns among obese patients who have previously failed to achieve significant weight loss only through lifestyle interventions. The findings are published in the journal Physiology and behavior.
Semaglutide is a drug that belongs to a class of drugs known as glucagon-like peptide-1 (GLP-1) analogs. It is used to treat obesity and is given once a week by subcutaneous injection. The drug works by mimicking the action of a natural hormone called GLP-1, which is involved in regulating appetite and food intake. Semaglutide is the active ingredient in Ozempic and is also available in a higher-dose formulation called Wegovy specifically indicated for chronic weight management.
Joanna Nicolau of the Balearic Islands Health Research Institute and her colleagues were motivated to study the impact of semaglutide on dietary patterns due to the increasing prevalence of obesity worldwide and the lack of effective interventions for long-term weight loss.
Despite advances in understanding the complex factors contributing to obesity, including metabolic, genetic, lifestyle, sociocultural, and environmental factors, there is still a need for more effective therapeutic options. Emotional eating, which involves eating in response to stress and negative emotions, is associated with obesity and difficulty managing weight.
GLP-1 analogs, including semaglutide, have shown promise in the treatment of obesity by acting on both the homeostatic (hunger-satiety) regions of the brain and the mesolimbic system, which is involved in hedonic (reward-based) overeating. However, the reasons for the different effectiveness of these drugs among obese individuals are not well understood. Individuals with emotional eating were observed to have altered brain responses to food cues and were less responsive to the central effects of GLP-1 receptor activation.
Previous studies with liraglutide, another GLP-1 analog, have demonstrated positive effects on weight loss and emotional eating. However, the current study aimed to investigate the effects of once-weekly semaglutide on emotional eating and food cravings among obese patients who had not achieved significant weight loss with lifestyle interventions alone.
The study methodology involved recruiting 69 obese patients who had previously failed to achieve or maintain significant weight loss despite lifestyle interventions. Most of these patients had previously been prescribed liraglutide 3 mg but discontinued its use. A significant proportion of participants had a personal or family history of obesity and obesity-related comorbidities such as hypertension. The average starting weight is 96.1 kg (211.9 lbs).
Patients were prescribed subcutaneous semaglutide weekly as adjunctive therapy to a lifestyle intervention program that included an adapted and hypocaloric diet and a minimum of 150 minutes of exercise per week.
The study assessed emotional eating using the Emotional Eater Questionnaire (EEQ), which is a ten-item questionnaire that assesses emotional eating behavior. Food cravings, psychological well-being and exercise levels were also assessed through structured interviews and the use of smartphone pedometers. Baseline measurements of height, weight, and BMI were taken, and these measurements were repeated after one and three months of semaglutide treatment.
Emotional eating was prevalent in the sample, with 72.5% of participants meeting criteria for emotional eating. There was a positive correlation between baseline BMI and the presence of emotional eating.
Binge eating (eating in response to external cues rather than hunger) was reported by 27.5% of participants, and almost half of participants had episodes of binge eating. Food cravings, both for salty and sweet foods, were common among participants.
After three months of treatment with semaglutide, a significant reduction in weight and BMI was observed. Approximately 30% of participants lost 1-5% of their weight and 36.2% of participants lost 5-10% of their weight, while smaller percentages achieved even greater weight loss. A minority of participants (8.7%) gained weight during the study period.
All types of abnormal eating patterns improved significantly after three months of semaglutide treatment. The prevalence of emotional eating, eating out, binge eating episodes, sweet and spicy cravings has decreased significantly.
“We found that the presence of emotional eating or other unusual eating patterns among participants in a weight loss program is very common. Fortunately, all of these dietary patterns that could negatively affect weight loss were significantly improved with semaglutide treatment associated with lifestyle interventions,” the researchers wrote.
Additionally, there was a significant increase in the proportion of participants who increased their exercise frequency to at least 150 minutes per week.
“Surprisingly, even just 3 months after starting the weight loss program, there was a significant increase in the proportion of patients who exercised regularly. “In this sense, these anti-obesity treatments, such as semaglutide, could act as motivational ‘triggers’ because of their rapid results,” Nicolau and her colleagues said.
But the study, like all research, comes with some caveats. As anti-obesity treatment is not reimbursed by the national health system in Spain, people seeking weight loss treatment in a clinic may have a higher socio-cultural status. This could lead to bias in the study population, the researchers note.
In addition, the study evaluated the effects of semaglutide after only three months. Longer-term studies would provide a more comprehensive understanding of the sustained effects and potential limitations of semaglutide treatment.
“Future research should include the effect of higher doses of semaglutide on eating habits in a real-world setting, larger long-term studies, as well as the comparison of these pharmacological treatments with psychological therapy,” the researchers concluded.
Learning, “Short-term effects of semaglutide on emotional eating and other abnormal eating patterns among subjects living with obesity“, is the author of Joana Nicolau, Antelm Pujol, Santiago Tofé, Aina Bonet and Apolonia Gil.