An integrated approach for obesity management: the effectiveness of glucagon-like peptide 1 agonist and life-style interventions for obesity management
Keywords:obesity, glucagon-like peptide 1 agonist, metformin, sodium-glucose cotransporter 2 inhibitors, life style intervention
Background. The obesity is found in 24.8 % (approximately 10 million people) and overweight in 34.3 % of the population of Ukraine, mainly in females. Obesity is associated with hereditary factors, overeating as well as a sedentary lifestyle. An integrated approach is applied to treat obesity such as combination of adequate eating behavior, high physical activity and administration of pharmacological correction, including glucagon-like peptide 1 agonist (GLP-1). Currently, the little is known about utility and effectiveness of GLP-1 in combination with adequate physical activity for obesity management among Ukrainian patients. The purpose of this study was to determine and evaluate the role of GLP-1 in combination with high physical activity for weight loss in obese patients and to compare with obese patients receiving treatment with metformin and sodium-glucose cotransporter 2 inhibitors (SGLT2i). Materials and methods. A prospective study included 155 obese patients, and follow-up data were available of 49 patients. The study group GLP-1 consisted of 30 patients receiving combination therapy GLP-1 liraglutide in daily doses of 1.2 to 3 mg per day. The control group consisted of 19 patients receiving complex therapy with metformin in daily doses from 500 to 2000 mg, and SGLT2i in daily doses from 10 to 12.5 mg. Body mass index (BMI), waist circumference (WC), hip circumference (HC), and WC/HC ratio were evaluated. Number of daily steps was determined using pedometers built into smartphones or smartwatches. Evaluation of the obtained data was performed using non-parametric statistical methods. Results. In study group GLP-1 the mean weight before the treatment was 104.6 kg, after treatment 96.36 kg (p = 0.000007), the mean weight lost was 7.8 % (range 1–23.71 %) of initial body weight. Mean BMI before treatment was 37.1 kg/m2, after treatment 34.11 kg/m2 (p = 0.000006). In the control group, the mean weight before the treatment was 99.4 kg, after treatment 91.74 kg (p = 0.000196), the mean weight lost was 7.73 % (range 0–16.9 %) of initial body weight. Mean BMI before treatment was 35.6 kg/m2, after treatment 34.11 kg/m2 (p = 0.000196). Analyses of the entrie chorot showed that before treatment, the daily number of steps > 5000/day was determined in 25 (51 %) patients, after treatment in 48 (98 %); the daily number of steps > 10,000/day before treatment was determined in 6 (11 %) patients, after treatment it was 5 times more frequent in 31 (63 %) patients. These results indicate a significant intensification of physical activity, and high motivation for weight loss in both study groups. Conclusions. Our findings suggest that weight loss in obese people is effective in case of administration of GLP-1, metformin, SGLT2i in combination with high physical activities of daily steps > 5000, which is part of life style intervention.
Sisson SB, Camhi SM, Tudor-Locke C, Johnson WD, Katzmarzyk PT. Characteristics of step-defined physical activity categories in U.S. adults. Am J Health Promot. 2012 Jan-Feb;26(3):152-159. doi:10.4278/ajhp.100326-QUAN-95.
Dwyer T, Ponsonby AL, Ukoumunne OC, et al. Association of change in daily step count over five years with insulin sensitivity and adiposity: population based cohort study. BMJ. 2011 Jan 13;342:c7249. doi:10.1136/bmj.c7249.
Harchenko NV, Anohina GA, Harchenko VV, Jakubovs'ka IA. The impact of personalized nutrition and dosed physical activity in the treatment of patients with gallbladder chronic diseases with concomitant obesity. Problems of aging and longevity. 2016;25(Suppl 1):173-180. (in Ukrainian).
Paluch AE, Bajpai S, Bassett DR,. Et al. Daily steps and all-cause mortality: a meta-analysis of 15 international cohorts. Lancet Public Health. 2022 Mar;7(3):e219-e228. doi:10.1016/S2468-2667(21)00302-9.
Bellastella G, Menafra D, Puliani G, Colao A, Savastano S; Obesity Programs of nutrition, Education, Research and Assessment (OPERA) Group. How much does obesity affect the male reproductive function? Int J Obes Suppl. 2019 Apr;9(1):50-64. doi: 10.1038/s41367-019-0008-2.
Velychko V, Mankovskyi B, Tatarchuk T, Lahoda D, Todurov I, Lishchyshyna O. A contemporary view on obesity treatment in adults: Literature review. Reproductive Endocrinology. 2021;(61):45-50. doi:10.18370/2309-4117.2021.61.45-50. (in Ukrainian).
Lingli X, Wenfang X. Characteristics and molecular mechanisms through which SGLT2 inhibitors improve metabolic diseases: A mechanism review. Life Sci. 2022 Jul 1;300:120543. doi:10.1016/j.lfs.2022.120543.
Zheng H, Liu M, Li S, et al. Sodium-Glucose Co-Transporter-2 Inhibitors in Non-Diabetic Adults With Overweight or Obesity: A Systematic Review and Meta-Analysis. Front Endocrinol (Lausanne). 2021 Aug 16;12:706914. doi:10.3389/fendo.2021.706914.
Pu R, Shi D, Gan T, et al. Effects of metformin in obesity treatment in different populations: a meta-analysis. Ther Adv Endocrinol Metab. 2020 May 21;11:2042018820926000. doi:10.1177/2042018820926000.
Naumova L, Milevska-Vovchuk L, Boiko Y, Naumova U, Gruba S. Cоmbined treatment of patients with grade 2 obesity. Bulletin of Medical and Biological Research. 2020;(4):49-52. doi:10.11603/bmbr.2706-6290.2020.4.11433. (in Ukrainian).
Gorobeiko M, Dinets A, Hoperia V, Abdalla K. Improved intraoperative verification of parathyroid glands by determining their autofluorescence in the infrared spectrum. Mìžnarodnij endokrinologìčnij žurnal. 2021;17(6):465-471. doi:10.22141/2224-07126.96.36.1991.243207. (in Ukrainian).
Gorobeiko M, Dinets A. Intraoperative detection of parathyroid glands by autofluorescence identification using image-based system: report of 15 cases. J Med Case Rep. 2021 Aug 9;15(1):414. doi:10.1186/s13256-021-03009-8.
Marchenko O, Gorobeiko M, Yuzvenko TY, Krushinska Z. Evaluation of the life quality in patients with diabetic foot syndrome before treatment and in the late period. Surgery of Ukraine. 2019;(2):56-60. doi:10.30978/SU2019-2-56. (in Ukrainian).
Tsymbaliuk I, Unukovych D, Shvets N, Dinets A. Cardiovascular complications secondary to Graves' disease: a prospective study from Ukraine. PLoS One. 2015 Mar 24;10(3):e0122388. doi:10.1371/journal.pone.0122388.
Brown E, Wilding JPH, Barber TM, Alam U, Cuthbertson DJ. Weight loss variability with SGLT2 inhibitors and GLP-1 receptor agonists in type 2 diabetes mellitus and obesity: Mechanistic possibilities. Obes Rev. 2019 Jun;20(6):816-828. doi:10.1111/obr.12841.
Johansen MY, Karstoft K, MacDonald CS, et al. Effects of an intensive lifestyle intervention on the underlying mechanisms of improved glycaemic control in individuals with type 2 diabetes: a secondary analysis of a randomised clinical trial. Diabetologia. 2020 Nov;63(11):2410-2422. doi:10.1007/s00125-020-05249-7.
Iqbal J, Wu HX, Hu N, et al. Effect of glucagon-like peptide-1 receptor agonists on body weight in adults with obesity without diabetes mellitus-a systematic review and meta-analysis of randomized control trials. Obes Rev. 2022 Jun;23(6):e13435. doi:10.1111/obr.13435.
Kovalenko TM, Zhabchenko IA, Liannoi you. Program of complex rehabilitation of pregnant women with alimentary-constitutional obesity in the third trimester. Pedagogics, psychology and medical-biological problems of physical training and sports. 2011;(3):79-83. (in Ukrainian).
How to Cite
This work is licensed under a Creative Commons Attribution 4.0 International License.