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 patients with obesity who had previously failed to achieve significant weight loss through lifestyle interventions alone. The findings have been published in the journal Physiology & Behavior.
Semaglutide is a medication that belongs to a class of drugs known as glucagon-like peptide-1 (GLP-1) analogues. It is used for the treatment of obesity and is administered once weekly via subcutaneous injection. The drug works by mimicking the action of a naturally occurring 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.
Joana Nicolau of the Health Research Institute of the Balearic Islands and her colleagues were motivated to study semaglutide’s impact on eating patterns due to the increasing prevalence of obesity worldwide and the lack of effective interventions for long-term weight loss.
Despite advancements 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, has been associated with obesity and difficulties in weight management.
GLP-1 analogues, including semaglutide, have shown promise in the treatment of obesity by acting on both the homeostatic (hunger-satiety) brain areas and the mesolimbic system, which is involved in hedonic (reward-based) overeating. However, the reasons for the varying effectiveness of these drugs among individuals with obesity are not well understood. It has been observed that individuals with emotional eating have altered brain responses to food cues and are less responsive to the central effects of GLP-1 receptor activation.
Previous studies with liraglutide, another GLP-1 analogue, have demonstrated positive effects on weight loss and emotional eating. However, the current study aims to investigate the effects of semaglutide once weekly on emotional eating and food cravings among patients with obesity who have not achieved significant weight loss with lifestyle interventions alone.
The methodology of the study involved recruiting 69 patients with obesity 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 had discontinued its use. A significant proportion of participants had a personal or family history of obesity and comorbidities related to obesity, such as hypertension. The average baseline weight was 96.1 kg (211.9 lbs).
The patients were prescribed weekly subcutaneous semaglutide as an adjunctive therapy to a lifestyle intervention program, which included a tailored 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 evaluates emotional eating behavior. Food cravings, psychological well-being, and exercise levels were also assessed through structured interviews and the use of step counters on smartphones. Baseline measurements of height, weight, and BMI were taken, and these measurements were repeated after one and three months of treatment with semaglutide.
Emotional eating was prevalent in the sample, with 72.5% of participants meeting the criteria for emotional eating. There was a positive correlation between baseline BMI and the presence of emotional eating.
External eating (eating in response to external cues rather than hunger) was reported by 27.5% of participants, and almost half of the participants experienced binge episodes. Food cravings, both for savory and sweet foods, were common among the participants.
After three months of treatment with semaglutide, there was a significant reduction in weight and BMI. 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 higher 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 treatment with semaglutide. The prevalence of emotional eating, external eating, binge episodes, sweet cravings, and savory cravings decreased significantly.
“We found that the presence of emotional eating or any other abnormal eating pattern among subjects entering a weight loss program was very frequent. Fortunately, all these eating patterns that could negatively interfere with the weight loss were significantly improved with the treatment of semaglutide 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 only after 3 months after the beginning of the weight loss program, there was a significant increase in the proportion of patients who exercise regularly. In this sense, these antiobesity treatments such semaglutide could act as motivational ‘triggers,’ due to their rapid results,” Nicolau and her colleagues said.
But the study, like all research, includes some caveats. Since antiobesity treatments are not reimbursed by the national health system in Spain, individuals seeking weight loss treatment at a clinic may have a higher sociocultural status. This could introduce a bias in the study population, the researchers noted.
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 investigations should include the effect of higher doses of semaglutide on eating patterns in a real-world setting, larger long-term studies as well as the comparison of these pharmacological treatments with psychological therapy,” the researchers concluded.
The study, “Short term effects of semaglutide on emotional eating and other abnormal eating patterns among subjects living with obesity“, was authored by Joana Nicolau, Antelm Pujol, Santiago Tofé, Aina Bonet, and Apolonia Gil.
