(PTFS05-01-26) Changes in Food Cravings, Dietary Intake, and Body Composition During GLP-1 Receptor Agonist Titration in Adults With Obesity

Objectives: To evaluate 24-week changes in food cravings and body composition among adults with overweight/obesity receiving GLP-1RA therapy in the prospective CRAVE study.

Methods: Adults with obesity prescribed semaglutide or tirzepatide were followed for 24 weeks (32 enrolled; 28 completed). SECA bioimpedance-derived body composition and validated craving surveys (FCI-II) were collected at baseline, midpoint (8-12 weeks), and endpoint (24 weeks). Primary outcomes were change in FCI-II total score, dietary intake, and changes in body composition. Analyses evaluated within-person change over time; medication-stratified results are presented descriptively.

Results: Over 24 weeks of GLP-1RA therapy, mean body weight decreased by 9.6% ± 5.5 (−20.0 lb; p < 0.001). Fat mass declined by 15.5 ± 11.0 lb (p < 0.001), accompanied by a 3.8 ± 2.4 lb reduction in skeletal muscle mass (p < 0.001). Overall food craving scores decreased modestly from baseline to week 24 (Δ −0.13 ± 0.72). Subscale analyses demonstrated reductions across multiple craving categories, including sweets (Δ −0.41), fast food (Δ −0.09), carbohydrates (Δ −0.11), and high-fat foods (Δ −0.13), with no significant differences observed between medication groups. Reductions in high-fat food cravings were significantly associated with decreases in dietary fat intake (r = −0.51, p = 0.038), whereas changes in carbohydrate or sweet cravings were not associated with corresponding macronutrient intake changes.

Conclusions: GLP-1RA therapy was associated with significant reductions in body weight and fat mass accompanied by modest decreases in food cravings. Reductions in high-fat food cravings were associated with decreases in dietary fat intake, suggesting a potential behavioral pathway linking pharmacologic treatment to dietary change. These findings indicate that GLP-1RA–mediated alterations in food preference may contribute to dietary behavior during weight loss, warranting further investigation in larger cohorts.

Funding Sources: Henry A Jastro Research Award College of Agricultural & Environmental Sciences UC Davis