"Effects of the GLP-1 analogue Semaglutide on Eating Behavior: A Comprehensive Systematic Review and Meta-Analysis"

Background: Obesity is a complex, progressive, and relapsing chronic disease distinguished by a body mass index (BMI) of 30 kg/m2. Etiology is complicated, involving genetic, epigenetic, physiological, behavioral, and environmental factors. According to recent World Health Organization (WHO) data, more than one billion people are obese in the world. This dramatic rise in the prevalence of obesity has increased the risk of morbidity and mortality due to a range of pathophysiologic consequences, including insulin resistance, dyslipidemia, cardiovascular diseases, type 2 diabetes (T2D), and non-alcoholic fatty liver disease. One prominent factor influencing feeding behavior and appetite is the anorexigenic gut peptide known as glucagon-like peptide-1 (GLP-1). This peptide exerts its regulatory effects both peripherally and centrally within the brain, playing a crucial role in the control of physiological and behavioral functions related to glycemic control and food intake. Although the impact of GLP-1 receptor agonists (GLP-1RAs) on these fundamental physiological processes has been partially investigated, their ability to modulate more intricate psychological functions, particularly those involving wider regions of the central nervous system, remains poorly understood. Investigating the potential influence of GLP-1RAs on these complex psychological functions can provide valuable insights into their broader neurobiological effects and shed light on their therapeutic potential in obesity management. Aim: The primary aim of this study is to provide a comprehensive and updated systematic review and meta-analysis of the information available about the effects of GLP-1 receptor agonist Semaglutide, on evaluated Visual Analog scores (VAS) of appetite, the Control of Eating Questionnaire (CoEQ) scores, and Emotional Eating Questionnaire scores in people with obesity or overweight. The objective is to assess psychological functioning, specifically focusing on domains associated with eating behaviors and food addiction. Methods: A systematic search was carried out using two databases, i.e., PubMed, and Scopus, from inception to August 28, to identify all observational studies and randomized controlled trials of patients with obesity (BMI ≥ 30 kg/m2) before and after Semaglutide therapy intervention, with pre-and post-intervention assessments using VAS, or CoEQ, or Emotional Eating Questionnaires. In addition, a meta-analysis of three trials that qualified for analysis was performed using ProMeta3 to evaluate overall appetite ratings and weight loss results. Results: After applying the inclusion criteria, a total of six studies were ultimately included. The systematic review examining the impact of Semaglutide on eating behavior and appetite revealed the following outcomes: 1) heightened satiety and reduced appetite, as evidenced by Visual Analog scores (VAS); 2) improved management of eating behaviors and control of eating, as indicated by enhanced scores on the Control of Eating Questionnaire (COEQ); 3) enhancements in the overall scores for eating behavior assessed through the Japan Society for the Study of Obesity (JASSO) questionnaire and the Emotional Eating Questionnaire. Furthermore, three trials were suitable for a meta-analysis based on data on weight loss and OAS. Semaglutide had a noticeable influence on both metrics. Conclusion: Comprehending the potential impact of GLP-1RAs on the psychological well-being of individuals dealing with obesity holds significant importance in crafting successful treatment strategies. GLP-1 analogs serve as a potent tool in managing obesity, as they can lead to decreased food consumption, ultimately aiding in weight reduction by curbing appetite, diminishing hunger, and influencing food preferences.