Abstract:
While GLP-1 agonists demonstrate e?cacy in trials, real-world discontinuation exceeds 50% at 6 months - a statistic re?ecting the limitations of medication-only approaches. Our Great Toronto Area (GTA)- based clinics’ multidisciplinary model (integrating CBT, body composition monitoring, and precision pharmacotherapy) has achieved 96% retention and unprecedented body recomposition in 129 patients (108F/21M). The results reveal not just superior outcomes, but critical age- and sex-speci?c patterns that rede?ne best practices. Postmenopausal women (>50yo) achieved ΔBF% -4.20 (95% CI [-4.5, -3.9]), doubling Look AHEAD trial benchmarks (p=0.002), while men >50yo matched this metabolic performance (-4.11percentage points (pp), CI [-4.8, -3.4]), defying expectations of age-related decline. Most strikingly, all groups maintained or gained lean mass (ΔSMM% +1.6-2.4pp), with women <30yo showing +2.68pp skeletal muscle mass (CI [+2.1, +3.3])
These achievements stem from three innovations: First, our proactive side-effect management protocol reduced GLP-1 discontinuation to 9% versus 31% in real-world cohorts through slow titration and anticipatory guidance. Second, 1:1 CBT sessions addressed emotional eating barriers. Third, biweekly body composition scans and AI-based food tracking application created powerful behavioral reinforcement, with body composition feedback sustaining engagement during plateaus (78% continued past 6 months). The data reveal striking correlations between monitoring frequency and outcomes (ΔBF%/SMM% correlation r=0.72, p<0.01), proving that what gets measured gets managed.
These ?ndings fundamentally reshape our understanding of obesity treatment e?cacy. The consistent lean mass preservation across all subgroups (ΔSMM% +1.6-2.4pp) challenges the prevailing weight-loss-at-all-costs paradigm, demonstrating that body recomposition - not just scale changes - should be the primary treatment target. The 0.72 correlation between monitoring frequency and outcomes (p<0.01) suggests these metrics may serve as early predictors of long-term success. Most importantly, the results provide biological evidence that multidisciplinary care isn't merely additive - it's transformative, creating synergistic effects where medication enhances lifestyle adherence while behavioral support optimizes pharmacotherapy persistence. This model offers clinicians an actionable blueprint to overcome obesity treatment's twin failures: metabolic adaptation and therapeutic attrition.