Work

Toward Precision Obesity Pharmacotherapy: Using the Eating Behavior Phenotype Scale (EFCA) in Real-World Clinical Practice

Year: 2026

Type: article

Abstract: BACKGROUND: , EFCA), differ across commonly used AOMs in a real-world cohort. METHODS: We conducted a retrospective, observational, real-world study in obesity outpatient care settings in São Paulo, Brazil. Adults with obesity (18-65 years) treated with a single principal AOM for 6 months and paired baseline/6-month follow-up EFCA and anthropometric data were included. Analyses focused on early responders (≥5% total body weight loss at 3 months). Five AOM groups available in Brazil were analyzed: semaglutide (oral or subcutaneous), naltrexone/bupropion, sibutramine, topiramate, and tirzepatide. Outcomes included percent weight loss, EFCA total score, and five EFCA subscales (hedonic, emotional, compulsive, hyperphagic, disorganized). Within-medication behavioral changes were assessed using paired tests and standardized effect sizes (Cohen's dz, 95% CI), summarized in heatmap form. RESULTS: The analytical cohort comprised 66 early responders with paired EFCA assessments at baseline and 6 months. EFCA profiling revealed distinct behavioral response fingerprints across AOMs. Effect size mapping showed predominantly large behavioral effects (many dz ≥ 0.8) in hedonic, emotional, hyperphagic, and compulsive domains. Strongest signals included emotional eating reductions with naltrexone/bupropion (dz 2.04), tirzepatide (dz 1.77), semaglutide (dz 1.52), and topiramate (dz 1.54); hedonic reductions with tirzepatide (dz 2.06), semaglutide (dz 1.55), and naltrexone/bupropion (dz 1.52); hyperphagic reductions with tirzepatide (dz 1.50) and semaglutide (dz 1.34); and compulsive reductions with topiramate (dz 1.41) and consistent effects across tirzepatide, semaglutide, and sibutramine (≈dz 0.95-0.96). Disorganized eating showed heterogeneous/attenuated responsiveness, from near-null with tirzepatide (dz 0.03) to large but imprecise effects in smaller groups (e.g., topiramate dz 1.24, wide CI). CONCLUSIONS: In this responder-enriched real-world cohort, AOMs showed distinct and reproducible EFCA behavioral signatures, supporting a clinically actionable phenotype-informed framework to prioritize, sequence, and monitor obesity pharmacotherapy beyond nonspecific weight reduction, while highlighting disorganization as a potential target for adjunctive behavioral strategies.

Source: Nutrients

DOI: 10.3390/nu18091419

Authors: Ronaldo José Pineda-Wieselberg, Andressa Heimbecher Soares, Thiago Fraga Napoli, Nilza Maria Scalissi, João Eduardo Nunes Salles

Institution: Irmandade da Santa Casa de Misericórdia de São Paulo

Language: English

Topic: Pharmacology and Obesity Treatment

Subfield: Pharmacology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,499