Combining GLP-1 Receptor Agonists and Health-Behaviour and Lifestyle Therapy Yields Higher Adherence and Reduces...

Evidence for the role of health behaviour and lifestyle treatment (HBLT) on the effectiveness of glucagon-like peptide-1 receptor agonists (GLP-1RAs) in paediatric obesity is limited.

To assess the role of HBLT on the effectiveness of GLP-1RAs in youth with obesity.

Patients aged 8-18 years with obesity (n = 51) receiving liraglutide were retrospectively divided into continuers (ongoing liraglutide treatment), discontinuers, or switches to semaglutide or metabolic-bariatric surgery. All were offered multidisciplinary HBLT and 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).

After 9.7 ± 6.6 months, a BMI reduction of ≥ 5% and ≥ 10% was observed in 37.3% and 13.7%, respectively. Relative change in BMI was higher in continuers compared to discontinuers (-6.7% ± 7.5% vs. -0.7% ± 5.1%, p = 0.03). Whereas 39.2% of patients continued liraglutide, 33.3% discontinued, mainly due to gastrointestinal symptoms. 27.4% of patients switched treatment to semaglutide or underwent surgery. Patients with combined HBLT and liraglutide had markedly higher odds of continuation (OR 18.5, 95% CI 2.0-929.8, p < 0.01) and greater reductions in BMI, which was by trend higher with OM-HBLT compared to HF-HBLT (BMI change -6.9% ± 7.2% vs. -4.0% ± 6.6%).

GLP-1RAs were effective in the real-world treatment of paediatric obesity. HBLT appears to be essential to increase persistence and efficacy of GLP-1RAs.