Abstract:
While GLP-1 agonists demonstrate efficacy in trials, real-world discontinuation exceeds 50% at 6 months - a statistic reflecting 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-specific patterns that redefine 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 (-4.11 percentage 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 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 results challenge the prevailing "prescribe-and-monitor" approach to obesity management. Just as diabetes care evolved from glucose-lowering to comprehensive metabolic management, obesity treatment must integrate behavioral and medical support as standard practice. Policy changes should include mandated coverage for group therapy, training in brief behavioral interventions for primary providers, and quality metrics that track muscle preservation alongside weight loss. Medications provide the tools, but multidisciplinary systems build the foundation for lasting success in obesity care. These findings fundamentally reshape our understanding of obesity treatment efficacy. 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
