Health-behavior and lifestyle therapy significantly increases liraglutide adherence and BMI reduction in adolescents with obesity.
Background
Managing pediatric obesity is challenging, with current treatments often facing issues like poor adherence and variable efficacy. While glucagon-like peptide-1 receptor agonists (GLP-1RAs) like liraglutide have shown promise, their real-world effectiveness in youth, particularly concerning the role of concurrent health behavior and lifestyle treatment (HBLT), remains underexplored. This gap highlights the need to understand how HBLT impacts GLP-1RA outcomes, especially given the chronic nature of obesity and the importance of sustained engagement for long-term success. Addressing this could optimize treatment strategies and improve patient persistence.
Study Design
This observational, real-world, single-center study retrospectively analyzed 51 patients aged 8-18 years with obesity receiving liraglutide. Patients were categorized into continuers, discontinuers, or those who switched to semaglutide or metabolic-bariatric surgery. All participants were offered multidisciplinary HBLT, consecutively allocated to either high-frequency (HF) HBLT (≥26 contact hours/year) or low-frequency obesity medication (OM)-specific HBLT (9 contacts of 0.5 h/year). The primary endpoints included BMI reduction and liraglutide treatment continuation rates over an average follow-up of 9.7 ± 6.6 months.
Results
After an average of 9.7 ± 6.6 months, a BMI reduction of ≥5% was observed in 37.3% of patients, and ≥10% in 13.7%. The relative change in BMI was significantly higher in liraglutide continuers compared to discontinuers (-6.7% ± 7.5% vs. -0.7% ± 5.1%, p=0.03). While 39.2% of patients continued liraglutide, 33.3% discontinued, primarily due to gastrointestinal symptoms. Another 27.4% switched treatment or underwent surgery. The most impactful finding was the strong association between HBLT and treatment persistence: > Patients receiving combined HBLT and liraglutide had markedly higher odds of continuation (OR 18.5, 95% CI 2.0-929.8, p<0.01). Furthermore, patients receiving OM-specific HBLT showed a trend towards greater BMI reduction compared to HF-HBLT (-6.9% ± 7.2% vs. -4.0% ± 6.6%), suggesting that even targeted, lower-frequency HBLT can be highly effective.
Key Findings
- Liraglutide reduced BMI by ≥5% in 37.3% of adolescents and ≥10% in 13.7% over 9.7 months.
- Patients continuing liraglutide showed significantly greater BMI reduction (-6.7% vs. -0.7%, p=0.03).
- Combined HBLT with liraglutide increased the odds of treatment continuation by 18.5x (p<0.01).
- OM-specific HBLT trended towards higher BMI reduction (-6.9%) compared to HF-HBLT (-4.0%).
- Gastrointestinal symptoms were the main reason for liraglutide discontinuation in 33.3% of patients.
Why It Matters
This study underscores that integrating structured health behavior and lifestyle therapy (HBLT) is crucial for maximizing the effectiveness and adherence of GLP-1RAs like liraglutide in adolescents with obesity. It suggests that GLP-1RAs are not standalone solutions but are significantly potentiated by concurrent lifestyle support. For clinicians and biohackers, this implies that simply prescribing a GLP-1RA without robust HBLT may lead to suboptimal outcomes and higher discontinuation rates. The finding that even lower-frequency, targeted HBLT can be highly effective offers a practical, scalable approach. Consider HBLT an essential co-intervention, not an optional add-on, when using GLP-1RAs for weight management in youth. This could inform future protocol designs, emphasizing comprehensive care models.
liraglutide
semaglutide
pediatric-obesity
obesity
glp-1-agonist
lifestyle-intervention