Glucagon-Like Peptide-1 Receptor Agonist-Based Agents and Body Composition: Filling More Gaps.

The last 2 decades have seen historic advances in the treatment of obesity. We are entering an era of defining obesity not by weight-based outcomes but by changes in body composition. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are forming the platform for obesity treatments based on their high level of efficacy. Body composition can be quantified by changes in percent fat/fat-free mass as a total of body weight. The amount of weight that is lost as % fat-free mass (% FFML) with diet-induced weight loss is ~25% but is extremely variable. Our aim was to provide an update to our previous report assessing changes in body composition using GLP-1 RA-based agents. In our updated review of 40 DXA-based reports, we found the mean (SD) % FFML was 29.1% (19.0%). Similar to our previous report, we found that the changes in body composition using these agents remain in the upper range of expected % FFML using other nonsurgical interventions for obesity. Functional measures of strength and performance and assessing body composition effects of future GLP-1-based agents are needed to understand the continued gaps that exist in determining the impact these treatments have, particularly in high-risk populations.