Once-weekly semaglutide improves eating control behaviors among adults with obesity
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Once-weekly semaglutide 2.4 mg is associated with reductions in hunger and improved fullness at 20 weeks as well as improved craving control at 2 years, according to findings from the STEP 5 randomized controlled trial.
As Healio previously reported, adults with obesity or a BMI of at least 27 kg/m2 with at least one weight-related comorbidity were randomly assigned to subcutaneous semaglutide 2.4 mg (Wegovy, Novo Nordisk) weekly or placebo for 104 weeks in STEP 5. At 2 years, the semaglutide group lost a mean 16.7% of their body weight. According to the latest STEP 5 data, published in Obesity, participants in the semaglutide group also had greater improvement compared with placebo in multiple self-reported eating behaviors at both short-term and long-term follow-up.
“Our results suggest that different aspects of control of eating were operative during initial weight loss (early time points) and weight-loss maintenance (later time point) with semaglutide treatment, and that an overall reduction in food cravings and craving for savory food was in effect throughout,” Sean Wharton, MD, PharmD, FRCPC, medical director of the Wharton Medical Clinic and adjunct professor at McMaster University in Hamilton, Canada, and York University in Toronto, and colleagues wrote. “These effects on control of eating were associated with [about] 15% weight loss and the maintenance of that weight loss up to 104 weeks.”
Of the 304 adults enrolled in STEP 5, 174 who self-reported eating control behaviors at baseline and all three follow-ups at 20, 52 and 104 weeks were included in the study (77.6% women; mean age, 47 years). Of the study cohort, 88 were in the semaglutide group and 86 were in the placebo group. A 19-item Control of Eating Questionnaire was conducted at baseline and each follow-up. Seventeen of the 19 questionnaire items fell under four domains: craving control, positive mood, craving for savory and craving for sweet. The remaining two items asked respondents about how hungry they felt and how full they felt.
Of those who completed all of the eating control questionnaires, the semaglutide group lost a mean 14.8% of their body weight at 104 weeks compared with a 2.4% weight reduction for the placebo group (P < .0001). The semaglutide group had a greater proportion of participants lose at least 5% of their body weight (74.7% vs. 33.3%), 10% of their body weight (57.8% vs. 10.1%), 15% of their body weight (49.4% vs. 2.9%) and 20% of their body weight (36.1% vs. 0%) compared with placebo.
Increased craving control with semaglutide at 2 years
At all three follow-ups, the semaglutide group had improved scores for craving control and craving for savory compared with baseline. Scores in the positive mood and craving for sweet domains were improved at 20 and 52 weeks compared with baseline in the semaglutide group. Improvements in all domains except positive mood were correlated with reductions in body weight at 104 weeks among the semaglutide group.
In an analysis of individual questionnaire items, the semaglutide group had greater reductions in desire to eat salty and spicy food, craving for dairy food, craving for starchy food, difficulty in resisting cravings, difficulty in control of eating and feelings of anxiety compared with placebo. Scores for hunger and fullness improved more with semaglutide than placebo from baseline to week 20 (P < .001). Scores for difficulty to resist cravings and control eating both improved more with semaglutide compared with placebo from baseline to all three follow-up points.
Adults with worse craving control at baseline lose more weight
Reductions in body weight among participants in the semaglutide group were greater for those with a worse ability to control cravings at baseline and for adults who had higher craving scores for savory or sweet food at baseline, the researchers wrote. Adults receiving semaglutide had slightly more weight loss from baseline to 104 weeks if they had a higher hunger score and lower fullness score at baseline. Participants in the semaglutide group who lost at least 20% of their body weight felt less hungry and fuller at all three follow-ups compared with those who lost less than 20% of their body weight.
“Semaglutide improves short- and longer-term control of eating, with participants reporting fewer cravings, reduced hunger and increased feelings of fullness,” the researchers wrote. “In addition, semaglutide prevents the compensatory increases in appetite that would otherwise be expected after substantial weight loss. Together, these changes most likely underlie the marked and sustained weight loss effects seen with once-weekly semaglutide 2.4 mg.”
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