ABSTRACT Background The use of glucagon‐like peptide‐1 receptor agonists (GLP‐1 RAs) for obesity management has gained widespread popularity and media attention. However, little is known about patients' knowledge related to GLP‐1 RAs (e.g., prescribing indications, side effects), how patients currently learn and wish to learn about GLP‐1 RAs, and how GLP‐1 RA use may impact weight‐related behaviors and attitudes within households (e.g., food purchasing patterns). Objective This study evaluated these questions among diverse adults recruited from a large, urban health system. Methods Participants were recruited to complete a brief online questionnaire through flyers posted in several outpatient clinics within a large health system. Recruitment occurred from November 2024 to April 2025. Descriptive statistics were calculated. Results Fifty‐two patients completed the questionnaire. Overall, 98% of participants had heard at least “a little” about GLP‐1 RAs. The conditions participants most commonly believed could benefit from use were obesity (88%), diabetes (75%), and high blood pressure (43%). The side effects they had heard most about were nausea/vomiting (71%), diarrhea (49%), and constipation (47%). Expected amount of weight loss and understanding of GLP‐1 RAs' mechanisms of action varied widely. The most common GLP‐1 RA information source was commercials/advertisements (73%); however, the most frequently preferred information source was healthcare professionals (87%). In exploratory analyses among patients with current or past GLP‐1 RA use and ≥ 1 other household member ( n = 12), 75% believed their use impacted adult household members' attention to weight, eating, or exercise; 50% believed GLP‐1 RA use impacted child/adolescents household members' attention to these matters; and 42% reported perceived weight loss among household adult(s). All GLP‐1 RA users reported changes in their household meal behaviors, and many reported shifts toward more healthful food purchases. Conclusion These findings suggest that many patients understand the primary indications for GLP‐1 RAs for obesity and common side effects, while also highlighting opportunities for improved decision support. Additional research on a potential “ripple effect” within households using larger samples and more robust methods is warranted.
ABSTRACT Objective Glucagon‐like peptide‐1 receptor agonists (GLP‐1 RAs) are effective treatments for obesity, but discontinuation is common due to cost, insurance coverage limitations, side effects, patient preference, and other factors. Weight regain often occurs rapidly after cessation, yet few evidence‐based strategies exist to support weight maintenance during this transition. This pilot randomized trial examined whether a digital wellness application or medically tailored meals (MTM) could mitigate weight gain during the first 4 months after GLP‐1 cessation. Methods In this pilot randomized trial, adults with prior GLP‐1‐induced weight loss were randomized to usual care, wellness application, or MTM at the time of GLP‐1 cessation. Surveys assessed adherence and satisfaction (primary outcome) as well as exploratory outcomes, diet quality, and perceived health. Weight (exploratory) was measured monthly using validated Bluetooth scales. Results Participants ( n = 39) were randomized to control ( N = 14), digital wellness application ( N = 12), or MTM ( N = 13) and had a mean baseline BMI 31.4 (SD 6.3) kg/m 2 . Diet quality, perceived health, adherence, and satisfaction did not significantly differ by group, though some estimates suggested possible trends favoring the wellness application. Relative to control, both the wellness application and MTM groups had less total weight gain: Wellness application −7.16% (95% CI: −12.27, −2.04) and MTM −7.17% (−12.20, −2.14). Conclusions These findings suggest that structured support may attenuate early weight gain after GLP‐1 cessation. Larger, more diverse trials with longer follow‐up and clinical outcomes are needed to confirm results and clarify mechanisms.
Objective:High-potency incretin therapy achieved substantial weight loss, but the extreme energy deficits it induced may obscure the underlying nutritional deterioration. This meta-analysis synthesized data from 19 randomized trials across the SURMOUNT, STEP, SCALE, and OASIS programs to quantify the nutritional and body composition consequences of these agents in adults with obesity. Methods:This systematic review and meta-analysis followed PRISMA 2020 guidelines. Risk of bias was assessed using the Cochrane RoB2 tool, and certainty of evidence was rated using the GRADE approach. Continuous outcomes were pooled using mean differences within a random-effects model. Results:Daily energy intake declined by 24.00%-39.20% across drug classes, with model-estimated daily deficits reaching 1200 kcal. Tirzepatide 15 mg was associated with a mean fat-free mass (FFM) reduction of 1.60 kg, representing 2.80% of body weight. Investigator-reported malnutrition occurred in only 0.12% of participants. Objective laboratory screening identified low total lymphocyte counts below 910 per microliter in 2.90% of active-therapy participants, nearly double the 1.77% in placebo arms, indicating that standard adverse event reporting underestimates true nutritional risk. Pancreatic lipase increased by a mean of 31% in the SCALE program, representing a secondary metabolic signal. Conclusions:Given these findings, a Tiered Stepped-Care Algorithm is proposed, mandating baseline screening of albumin and total lymphocyte count, periodic monitoring at weeks 12, 24, and 52, and defined intervention thresholds to prevent sarcopenia and frailty, particularly in adults aged 65 years and older.
Background:Weight management in children involves family lifestyle changes and relies on caregivers of children to implement these changes at home. Little is known about the effects of family-based lifestyle intervention programs for children on caregivers themselves when not specifically targeted by the intervention. Objective:To assess whether primary caregivers of children and adolescents with overweight or obesity experience a change in body mass index (BMI), cardiovascular risk profile and/or health behaviors while participating in a pediatric weight management program. Methods:A prospective cohort study followed caregivers who participated in a family-based multidisciplinary pediatric weight management clinic with their child for 1-year at Alberta Children's Hospital (Alberta, Canada). Data collection occurred from 2015-2019 and included baseline, 6 months and 12 months. Results:Ninety-nine caregivers completed baseline evaluations and 48 completed the baseline labs. At 6-months, 45 completed evaluations, and 23 completed labs. At 12-months, 31 completed evaluations and 22 completed labs. At baseline, 18.2% of caregivers were overweight (BMI 25-29.9 kg/m2) and 65.7% were living with obesity (BMI ≥ 30 kg/m2). There was no significant change in weight (median change -3.25 × 10-5 kg; p = 1), BMI (median change 0.050 kg/m2; p = 0.80) or waist circumference (median change 0.050 cm; p = 0.88) at 6 months. No statistically significant changes in cardiometabolic labs were found between baseline and 6 months when controlled for the addition of antihypertensives or antihyperglycemics. Conclusion:This study provides insight into metabolic outcomes of the caregivers of overweight and obese children enrolled in a family-based lifestyle intervention program, although this study was limited by the small sample size and loss of follow-up. Future studies should continue to evaluate caregivers, to better understand the relationship between caregiver involvement and their outcomes in association with their child. Additional understanding of potential psychosocial benefits to children and families enrolled in these programs would be of further benefit.
Objective:Use of GLP-1 receptor agonists is associated with significant weight loss in many individuals. Discontinuation is associated with weight regain. Patients' experience with this is not well characterized. This study describes the patient experience of continuity of care. Methods:A cross-sectional electronic survey was administered to adults identified from an academic medical center's electronic health records as having at least one GLP-1 RA prescription in the preceding 6 years and a subsequent prescription gap of greater than 90 days. The 87-item instrument spanned six domains: care settings, comorbidity and treatment context, continuity, discontinuity, dietitian/lifestyle support, and digital-feature preferences. Primary outcomes were item-level frequencies. Exploratory composites included a 7-item Continuity-of-Care Index (CCI) and a 5-item Discontinuity Index (DIS), each rescaled 0-100; subgroup comparisons used Kruskal-Wallis, Mann-Whitney, and chi-square tests, with multiple-imputation sensitivity analyses. Results:Of 4890 invitations, 261 adults completed the survey (5.3%); 143 (54.8%) reported current use of a prescription weight-management medication and 159 (60.9%) reported prior-authorization requirements. Among them, 79 (49.7%) either waited more than 7 days or were never approved. Continuity strengths included knowing whom to contact about medications (76.2%) and timely team responses (70.7%); the weakest items were cross-clinic coordination (54.1%) and visibility into required next steps (52.2%). The CCI (mean 69.5 [SD 22.7]; α = 0.90; n = 242) varied by most-visited clinic (Kruskal-Wallis p < 0.001), highest at the weight-management clinic (median 82.1) and lower at primary care (60.7). Among current medication users, 32.4% reported a ≥ 14-day medication gap. The most desired digital features were all-in-one tracking of refills, prior authorization, and appointments (89.5%) and real-time prior-authorization status (87.2%). Conclusions:Patients described obesity-care disruptions primarily as process failures, including prior authorization delay, out-of-pocket cost, pharmacy stock-outs and dispensing delays, and fragmented cross-clinic coordination. They prioritized transparent, workflow-oriented navigation.
