Beyond weight loss: predictors of treatment satisfaction and patient-reported outcomes in incretin-based therapies. A cross-sectional study.

BACKGROUND: Incretin-based therapies, including glucagon-like peptide-1 receptor agonists and dual glucose-dependent insulinotropic polypeptide/glucagon-like peptide-1 receptor agonists, have demonstrated substantial efficacy in weight management. However, real-world treatment experience, tolerability, and treatment continuation remain important challenges, and the determinants of patient satisfaction are not fully understood. METHODS: A cross-sectional online survey was conducted between January and February 2025 across international incretin therapy communities. The study included 411 adults with obesity (BMI ≥30 kg/m²) or overweight with comorbidities (BMI 27-29.9 kg/m²) receiving semaglutide or tirzepatide for ≥3 months. Treatment satisfaction was assessed using the validated Treatment-Related Impact Measure-Weight (TRIM-Weight). Patient-reported changes in appetite regulation, mood, physical activity, sexual health, self-image, and social experiences were evaluated using 5-point Likert scales. RESULTS: Participants had a median age of 39 years (IQR 33-47), 71.8% were female, and the median treatment duration was 10 months (IQR 7-13), with 34.3% reporting treatment for ≥12 months. In univariate analyses, higher treatment satisfaction was associated with improvements in appetite regulation, mood, physical activity, sexual satisfaction, self-image, and positive social feedback, as well as fewer limitations due to side effects (all p < 0.05). In fully adjusted multivariable models, fewer limitations due to side effects (β = 1.41; 95% CI 0.25-2.88), increased satiety (β = 0.68; 95% CI 0.10-1.29), improved mood (β = 0.69; 95% CI 0.19-1.28), and higher physical activity (β = 0.58; 95% CI 0.10-1.17) remained independently associated with higher TRIM-Weight scores. Greater BMI reduction was associated with higher treatment satisfaction in the individually adjusted model, but this association was attenuated and no longer statistically significant in the fully adjusted model. CONCLUSIONS: Treatment satisfaction was more strongly associated with tolerability, satiety, mood, and physical activity than with BMI change or medication type. These findings support incorporating patient-reported outcomes when evaluating incretin-based therapies in real-world obesity care.