Liraglutide 3.0 mg and mental health: can psychiatric symptoms be associated to adherence to therapy? Insights from a clinical audit.

INTRODUCTION: Liraglutide 3.0 mg, a glucagon-like peptide-1 (GLP-1) analogue, is a medication approved for obesity treatment. This study aimed to investigate the relationship between psychiatric symptoms, including depression, anxiety, and binge eating, and their impact on therapy adherence. METHODS: A clinical audit was carried out on a cohort of 54 adults with obesity treated with liraglutide 3.0 mg. We retrospectively analyzed the connection between psychiatric symptoms assessed through the State-Trait Anxiety Inventory (STAI), Beck Depression Inventory (BDI), and Binge Eating Scale (BES). Adherence to therapy was assessed by the maximum dosage (MD) and treatment duration (TD). RESULTS: Notably, a discontinuation rate of 59% was encountered. However, among those who continued the treatment, we observed a negative association between anxiety symptoms (STAI score) and MD, depression symptoms (BDI score) and TD, and a higher likelihood of binge eating (BES score > 17) and TD. Moreover, presence of psychiatric symptoms did not compromise drug's effectiveness in achieving weight loss, which was 4.43% (± 5.5 SD) in the whole sample and 5.3% (± 6.3 SD) in the subgroup evaluated at 12 weeks. CONCLUSION: We observed a high discontinuation rate in real-life clinical setting, where Liraglutide 3.0 therapy is paid out-of-pocket. While psychiatric symptoms might play a role in diminishing adherence to therapy, they do not prevent drug's effectiveness to promote weight loss. This finding underscores the potential advantages of liraglutide 3.0 mg therapy for individuals contending with obesity while simultaneously managing mental health challenges. LEVEL OF EVIDENCE: Level V, descriptive studies.

Promoting weight loss and psychological well-being in patients with obesity: A sequential combination of behavioural lifestyle intervention and well-being therapy.

Behavioural lifestyle interventions focused on diet and physical activity are a cornerstone for the treatment of obesity. However, their effects vary substantially across individuals in terms of magnitude and durability. Personalized approaches that target psychological well-being may be promising to facilitate healthy behaviours and sustained weight loss. This preliminary study aimed to explore whether the sequential combination of behavioural lifestyle intervention (BLI) and well-being therapy (WBT) may result in more favourable outcomes than BLI alone in promoting weight loss (primary outcome) and improving psychological well-being, distress, dietary behaviours and physical activity (secondary outcomes). A total of 83 patients with obesity were randomly assigned to BLI/WBT (N = 38) or BLI group (N = 45). The BLI group received a 12-week behavioural weight loss programme, whereas the BLI/WBT group received the same programme followed by an additional 4-week WBT, adapted for group interventions. Data were collected at pretreatment (baseline, T1), at the end of BLI/WBT (T2), at 6-month (T3) and 12-month (T4) follow-ups. There was a significant weight loss in both treatment groups at T2, T3 and T4. The BLI/WBT group showed greater improvements in depressive symptoms at T3 and T4, in autonomy at T2, in personal growth at T4 and in global well-being at T4 compared with BLI group. WBT yielded no additional effect on weight loss. However, the secondary outcomes indicate that WBT may have enduring effects that reduce vulnerability to psychological distress in patients with obesity. In order to confirm these preliminary findings and explore whether a more intensive and individualized WBT can foster sustained weight loss, future studies are needed.

The Role of Psychological Well-Being in Weight Loss: New Insights from a Comprehensive Lifestyle Intervention / El papel del bienestar psicológico en la pérdida de peso: nuevos conocimientos acerca de una intervención integral en el estilo de vida

Background/Objective: Although the literature suggested that impaired psychological well-being (PWB) is associated with obesity, evidence on the role of PWB in weight outcomes is limited and inconclusive.This research aimed to investigate the joint role of PWB in achieving clinically significant weight loss (CWL; loss of 5% of the initial weight) through a comprehensive lifestyle intervention for obesity using a broad-based evaluation. Method: This study is a prospective cohort of 96 patients with obesity attending a comprehensive lifestyle intervention for weight loss. Data on weight, lifestyle, PWB, and distress, were collected before and after the intervention. Results: 30.5% of the participants achieved CWL at the end of treatment. A more pronounced increase in autonomy (odds ratio = 0.80 [95% CI: 0.68, 0.93], p ≤ .01) and somatization (odds ratio = 0.83 [95%CI: 0.70, 0.98], p ≤ .05) from pre- to post-treatment were independently associated with a lower probability of CWL. Conclusions: Unbalanced dimensions of PWB, in particular exceedingly high autonomy, may contribute to a poor weight loss outcome. This study paves the way for the addition of psychotherapeutic strategies geared to euthymia in comprehensive lifestyle intervention.

Antecedentes/Objetivo: Aunque la literatura sugiere que el deterioro del bienestar psi-cológico (BP) está asociado con obesidad, la evidencia sobre el papel del BP en el peso es limitada. Se investiga el papel del BP en el logro de pérdida de peso clínicamente signi-ficativa (PPCS; pérdida del 5% del peso inicial) a través de una intervención integral sobre el estilo de vida con respecto a la obesidad. Método: Cohorte prospectiva de 96 pacientes con obesidad que asisten a una intervención integral sobre el estilo de vida para la pér-dida de peso. Se recolectaron datos sobre peso, estilo de vida, BP y angustia, antes y después de la intervención. Resultados: El 30,5% de los participantes lograron pérdida de peso al final del tratamiento. Mayor aumento de autonomía (razón de momios = 0,80 [ICdel 95%: 0,68, 0,93], p ≤ 0,01) y somatización (razón de momios = 0,83 [IC del 95%: 0,70, 0,98], p ≤ 0,05) de antes a después del tratamiento se asociaron de forma independiente con menor probabilidad de PPCS. Conclusiones: Las dimensiones desequilibradas del BP, en particular la autonomía excesivamente alta, pueden contribuir a una pérdida de peso insuficiente. Se allana el camino para añadir estrategias psicoterapéuticas orientadas a la eutimia en la intervención integral en el estilo de vida.

The Role of Psychological Well-Being in Weight Loss: New Insights from a Comprehensive Lifestyle Intervention.

BACKGROUND/OBJECTIVE: Although the literature suggested that impaired psychological well-being (PWB) is associated with obesity, evidence on the role of PWB in weight outcomes is limited and inconclusive. This research aimed to investigate the joint role of PWB in achieving clinically significant weight loss (CWL; loss of 5% of the initial weight) through a comprehensive lifestyle intervention for obesity using a broad-based evaluation. METHOD: This study is a prospective cohort of 96 patients with obesity attending a comprehensive lifestyle intervention for weight loss. Data on weight, lifestyle, PWB, and distress, were collected before and after the intervention. RESULTS: 30.5% of the participants achieved CWL at the end of treatment. A more pronounced increase in autonomy (odds ratio = 0.80 [95% CI: 0.68, 0.93], p ≤ .01) and somatization (odds ratio = 0.83 [95% CI: 0.70, 0.98], p ≤ .05) from pre- to post-treatment were independently associated with a lower probability of CWL. CONCLUSIONS: Unbalanced dimensions of PWB, in particular exceedingly high autonomy, may contribute to a poor weight loss outcome. This study paves the way for the addition of psychotherapeutic strategies geared to euthymia in comprehensive lifestyle intervention.

CONTEXTO/OBJETIVO: Aunque la literatura sugiere que el deterioro del bienestar psicológico (BP) está asociado con obesidad, la evidencia sobre el papel del BP en el peso es limitada. Se investiga el papel del BP en el logro de pérdida de peso clínicamente significativa (PPCS; pérdida del 5% del peso inicial) a través de una intervención integral sobre el estilo de vida con respecto a la obesidad. MÉTODO: Cohorte prospectiva de 96 pacientes con obesidad que asisten a una intervención integral sobre el estilo de vida para la pérdida de peso. Se recolectaron datos sobre peso, estilo de vida, BP y angustia, antes y después de la intervención. RESULTADOS: El 30,5% de los participantes lograron pérdida de peso al final del tratamiento. Mayor aumento de autonomía (razón de momios = 0,80 [IC del 95%: 0,68, 0,93], p ≤ 0,01) y somatización (razón de momios = 0,83 [IC del 95%: 0,70, 0,98], p ≤ 0,05) de antes a después del tratamiento se asociaron de forma independiente con menor probabilidad de PPCS. CONCLUSIONES: Las dimensiones desequilibradas del BP, en particular la autonomía excesivamente alta, pueden contribuir a una pérdida de peso insuficiente. Se allana el camino para añadir estrategias psicoterapéuticas orientadas a la eutimia en la intervención integral en el estilo de vida.

Emotional intelligence, emotion regulation and affectivity in adults seeking treatment for obesity.

Obesity has become an increasingly widespread endemic with social implications; however, the relationship between higher body mass index (BMI) and psychological functioning is still not fully understood. This study examined the differences in affect-related psychological variables among BMI classes. A total of 134 adults seeking treatment for obesity and 124 controls completed a set of questionnaires to assess: trait emotional intelligence, emotion regulation strategies, anxiety, depression, binge eating behaviors and happiness. Correlations and multivariate analysis of variance were run per each study variable controlling for BMI class (normal weight, overweight, or obesity class I, II, III). Individuals with obesity class III were characterized by reduced trait emotional intelligence and happiness, and a higher tendency to use emotion suppression compared to normal weight individuals. All individuals with obesity also showed higher levels of depression and binge eating behaviors compared to both normal weight and overweight adults. Depression and emotion suppression were the most relevant discriminant factors across BMI classes, while trait emotional intelligence resulted as an important psychological factor clustering individual differences between obese and non-obese individuals. These results suggest that more attention to the affective domain of psychological functioning is needed for proper and comprehensive treatment of obesity.

Physical activity support or weight loss counseling for nonalcoholic fatty liver disease?

AIM: To determine the clinical effectiveness of intense psychological support to physical activity (PA) in nonalcoholic fatty liver disease (NAFLD), compared with cognitive-behavioral treatment (CBT). METHODS: Twenty-two NAFLD cases received support to exercise, tailored to their motivational needs (PA group). The effects on body weight, physical fitness [6-min walk test, VO2max and the PA-rating (PA-R) questionnaire] and body fat (fatty liver indices and visceral adiposity index) were compared with data obtained in 44 NAFLD subjects enrolled in a CBT program for weight loss, after adjustment for propensity score, calculated on baseline data. Measurements were performed at baseline, at 4-mo and one-year follow-up. Changes in anthropometric, biochemical and PA parameters were tested by repeated measurement ANOVA. Outcome results were tested by logistic regression analysis. RESULTS: At the end of the intensive program, BMI was less significantly reduced in the PA group (-1.09 ± 1.68 kg/m(2) vs -2.04 ± 1.42 kg/m(2) in the CBT group, P = 0.019) and the difference was maintained at 1-year follow-up (-0.73 ± 1.63 vs -1.95 ± 1.88, P = 0.012) (ANOVA, P = 0.005). PA-R was similar at baseline, when only 14% of cases in PA and 36% in CBT (P = 0.120) recorded values ≥ 3. At 4 mo, a PA-R ≥ 3 was registered in 91% of PA and 46% of CBT, respectively (P < 0.001) and PA-R ≥ 5 (up to 3 h/wk of moderate-to-heavy intensity physical activity) was registered in 41% of PA and only 9% of CBT group (P < 0.007). The 6-min walk test increased by 139 ± 26 m in PA and by only 43 ± 38 m in CBT (P < 0.001) and VO2max by 8.2 ± 3.8 mL/kg per minute and 3.3 ± 2.7 mL/kg per minute, respectively (P < 0.002). After adjustment for propensity, weight loss > 7% was significantly associated with CBT group at one year (OR = 6.21; 95%CI: 1.23-31.30), whereas PA-R > 3 was associated with PA group (10.31; 2.02-52.63). Liver enzymes decreased to values within normal limits in 36% of PA cases and 61% of CBT (P < 0.070). Estimated liver fat (Kotronen index) fell below the fatty liver threshold in 36% of PA and 34% and CBT cases at one-year (not different). Also the fatty liver index and the visceral adiposity index improved to a similar extent. CONCLUSION: Intensive psychological counseling for PA produces hepatic effects not different from standard CBT, improving physical fitness and liver fat independent of weight loss. Strategies promoting exercise are worth and effective in motivated patients, particularly in lean NAFLD patients where large weight loss cannot be systematically pursued.

A psychological support program for individuals with Type 1 diabetes.

We aimed to test the effects of a psychological support program on the psychological distress, mood, and quality of life of well-educated individuals with type 1 diabetes. A newly developed support program was offered to 60 patients with type 1 diabetes on intensive insulin treatment, previously enrolled in group-care educational programs. Thirty-three subjects participated (experimental group, in groups of 8-12 subjects); 22, who postponed their entry, were used as controls. The program consisted of 7 weekly work sessions of 2 hours chaired by a psychologist and covered aspects of daily living with diabetes using role-playing, metaplan, and problem solving. At baseline and approximately 6 months later, all participants completed a battery of questionnaires, and the differences between the experimental and the control group were analyzed by repeated-measurements ANOVA. In response to the psychological support program, subjects in the experimental group reduced their depressive mood (Beck Depression Inventory and depression scales of the Psychological Well-Being Index) and anxiety (Self-rating Anxiety Scale), improved disease-specific quality of life (Symptom and Well-Being scales of the Well-Being Enquiry for Diabetes), increased their internal and decreased their external locus of control. These changes were accompanied by a 0.3% decrease in glycosylated hemoglobin, whereas no significant changes were observed in the control group (ANOVA, P = 0.032). These results underline the importance of psychological aspects in individuals with type 1 diabetes; treating the psychological aspects related to the disease may be as important as medical control in order to improve living with diabetes.