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Editor: David L. Joffe, BSPharm, CDE, FACA


Author: Amanda Roberts, PharmD candidate, Florida A&M University, College of Pharmacy and Pharmaceutical Sciences Institute of Public Health

Studies have shown that emotional eating and other eating habits and behaviors may reduce weight loss when taking GLP-1 receptor agonists.

Emotional eating involves eating to respond to negative emotions while ignoring internal physiological hunger cues. Emotional food scores have been linked to obesity, less weight loss after weight loss programs, and weight regain after intervention. Emotional eating is also associated with impaired brain signaling in reward processing areas. Additionally, obesity and type 2 diabetes mellitus are linked to changes in reward processing zones.

Treatment option for obesity and type 2 diabetes mellitus GLP-1 receptor (GLP-1RA) agonists are effective due to suppression of appetite signaling in the brain. Previous studies have shown that emotional eating is associated with lower sensitivity to GLP-1 receptor activation and the effects of appetite signaling in the brain after short-term treatment. However, the following eating styles have not yet been evaluated: restraint eating (cognitive control of food intake to control body weight) and external eating (overeating due to external cues related to body weight). food, such as sight and smell). In this study, researchers investigated whether people with type 2 diabetes with different eating styles were less responsive to GLP-1RA after long-term treatment.

This open-label, randomized crossover intervention study was a secondary analysis of the LIBRA study. The LIBRA study aimed to assess the effect of liraglutide versus insulin glargine on brain activation in response to food cues using functional magnetic resonance imaging. This secondary analysis created two treatment periods for 12 weeks and a 12-week washout period in between. Over a treatment period, patients received liraglutide in increasing doses each week until a final dose of 1.8 mg per day was reached. Patients received insulin glargine 10 IU daily during the other treatment period. The dose was increased based on self-monitored fasting blood glucose. Three test visits were made for each treatment period at baseline, ten days and 12 weeks. Patients had functional magnetic resonance imaging examinations performed fasting and in postprandial conditions. Visual food cues were also presented to the patients. At the end of the visit, patients received a food buffet where their energy intake was monitored. The Dutch Eating Behavior Questionnaire (DEBQ) was used to determine baseline emotional, external, and restraining eating scores. Longitudinal differences between treatments were analyzed using a generalized estimating equation approach. Pearson’s regression coefficients were used to establish associations between eating behaviors and differences in brain activation. The results were significant at P 26 kg/m² and were treated with metformin with or without sulfonylurea derivatives. Exclusion criteria included patients with a history of centrally acting agent or glucocorticoid use.

Fasting baseline emotional food scores were negatively associated with liraglutide-induced reductions in the left caudate (p=0.055) in response to high-calorie images compared to non-food images after 12 weeks of treatment. Similar results were found in the postprandial state in the left caudate (p = 0.055). However, baseline emotional food scores were not associated with brain responses after receiving chocolate milk versus a tasteless solution after 12 weeks of treatment.

Baseline external food scores were negatively correlated with liraglutide-induced reductions in fasting condition, versus insulin glargine in response to food images versus non-food images in the right insula (r = – 0.63, p = 0.047), after 10 days of treatment. Baseline food scores were negatively correlated with liraglutide-induced reductions in the postprandial state, in the right insula (r=-0.77, p=0.003) in response to food images compared to non-food images , and in bilateral amygdala (right, r=–0.–0.54, p=0.043; left, r=–0.68 p=0.005) and right insula (r=0.67, p=0.026) after 10 days of treatment. There was no association between external dietary scores and brain responses after 12 weeks of treatment.

Baseline food restriction scores had a positive association with liraglutide-over-insulin glargine-induced increases in the right putamen (p=0.084) and right insula (p=0.060) after receiving milk at the chocolate compared to a tasteless solution, after 10 days of treatment. Baseline dietary restriction scores had a positive association with liraglutide-induced reductions in the fasting condition, in the right and left insula (p=0.049, r=0.61; p=0.001, r=0, 79, respectively) in response to food versus non-handling. food images, and in the left insula (p=0.027, r=0.64) and right caudate nucleus (p=0.043, r=0.60) in response to high-calorie images compared to non-food images. food, after 12 weeks of treatment.

This study found that, at baseline, higher emotional food scores were correlated with less pronounced GLP-1RA-induced changes in the brain’s response to receiving food and food images in people with diabetes. type 2 after ten days of treatment. This was also observed to a lesser extent after 12 weeks of treatment. Additionally, baseline external dietary scores were associated with fewer GLP-1 RA-induced changes in brain response after ten days of treatment. However, higher baseline dietary restriction scores were correlated with GLP-1RA-induced changes in brain responses after 12 weeks of treatment. These data suggest that elements of emotional eating make individuals less responsive to GLP 1-RA treatment.

In addition, external feeding may also decrease, while restricted feeding may increase the patient’s susceptibility to the effects of GLP-1 PRs. These results may explain why GLP-1RAs are not associated with significant weight loss in all patients. Therefore, future studies should be conducted on larger and more diverse patient populations for longer periods of time to continue to examine the impact of eating behavior on the effects of GLP-1 PRs.

Practice Beads:

  • Emotional eating habits reduced the effects of GLP-1 PRs in patients with type 2 diabetes.
  • Eating behaviors/habits may play a role in weight loss when a patient is taking GLP-1 PRs.
  • Eating behaviors need to be addressed to optimize treatment strategies for overweight patients.

van Ruiten, Charlotte C et al. “Eating behavior modulates sensitivity to central effects of GLP-1 receptor agonist treatment: a secondary analysis of a randomized trial.” Psychoneuroendocrinology vol. 137 (2022): 105667. doi:10.1016/j.psyneuen.2022.105667

Amanda Roberts, PharmD candidate, Florida A&M University, College of Pharmacy and Pharmaceutical Sciences Institute of Public Health