Semaglutide Treatment, Appetite, and Eating Behavior: Long-term Effects (STABLE Wt Loss)
Primary Purpose
Obesity
Status
Recruiting
Phase
Phase 4
Locations
United States
Study Type
Interventional
Intervention
Behavioral Treatment
Placebo
Semaglutide 2.4 MG/0.75 ML Subcutaneous Solution [WEGOVY]
Sponsored by
About this trial
This is an interventional treatment trial for Obesity focused on measuring Semaglutide, Body weight, Obesity, weight loss, medication, overweight, lifestyle modification, diet, exercise, Body Weight Changes, Appetitive Behavior
Eligibility Criteria
Inclusion Criteria:
- Men and women who report a desire to lose weight
- Aged 18-70 years
- Body mass index [BMI] ≥ 30 kg/m2 or BMI ≥ 27 kg/m2 with an obesity-related comorbidity (e.g., treated or untreated hypertension, dyslipidemia, obstructive sleep apnea, or cardiovascular disease)
Eligible female patients will be:
- non-pregnant, evidenced by a negative urine pregnancy test
- non-lactating
- surgically sterile or postmenopausal, or they will agree to continue to use an accepted method of birth control during the study
Subjects must
- Plan to remain in the Philadelphia area for the next 1.5 years.
- Ability to provide informed consent before any trial-related activities.
Exclusion Criteria:
- A diagnosis of type I or II diabetes
- Hemoglobin A1c (HbA1c) > 6.5%
- Uncontrolled hypertension (blood pressure ≥ 160/100 mm Hg)
- Clinically significant hepatic (i.e., liver fibrosis, cirrhosis or confirmed NASH) or renal disease
- Uncontrolled thyroid disease
- Experienced a cardiovascular event (e.g., stroke, myocardial infarction) in the last 6 months, congestive heart failure, or heart block greater than first degree
- A history of acute pancreatitis in the last 6 months
- Any history of chronic pancreatitis
- A history of malignancy (other than non-melanoma skin cancer) within the last 5 years
- A personal or family history of medullary thyroid cancer or multiple endocrine neoplasia syndrome type 2
- A self-reported change in body weight >5kg (11 lbs) within 90 days before screening
- Used within the last 6 months medications known to produce weight loss/gain (e.g., medications approved for weight loss, oral steroids, antipsychotic medications) or any GLP-1 receptor agonist.
- Known or suspected allergy or hypersensitivity to trial medication(s), excipients, or related products
- The receipt of any investigational drug within 6 months prior to this trial
- Applicants with current severe major depressive disorder (BDI-II score ≥ 29 or Patient Health Questionnaire-9 [PHQ-9] score > 15) or severe anxiety disorder
- Applicants with current, active suicidal ideation, and/or a suicide attempt within the past year (such individuals will be referred for psychiatric treatment if they have not previously received it).
- Any severity of psychotic or bipolar disorder
- Bulimia nervosa diagnosis within the past 5 years
- Self-reported alcohol or substance abuse within the past 6 months, including at-risk drinking (current consumption of ≥ 14 alcoholic drinks per week)
- History of (or plans to receive in the next 1.5 years) bariatric surgery or a weight loss device. (However, the following will be allowed: liposuction or abdominoplasty > 1 year before screening, laparoscopic banding if removed > 1 year before screening, intragastric balloon or aspire assist if removed > 1 year before screening.)
- Inability to walk 5 blocks or more (comfortably) or engage in another form of aerobic activity.
- Women who are nursing, pregnant, or planning to become pregnant in the next 1.5 years or are not using adequate contraceptive measures
- Previous participation in this trial (e.g., randomized but failed to participate)
- Changes to any chronic medication (type or dosage) within the past 3 months.
- Food allergy or dietary preference that would prevent the individual from consuming the standard breakfast or ad libitum lunch.
Sites / Locations
- University of Pennsylvania Center for Weight and Eating DisordersRecruiting
Arms of the Study
Arm 1
Arm 2
Arm Type
Active Comparator
Active Comparator
Arm Label
Behavioral Treatment + Placebo
Behavioral Treatment + Medication
Arm Description
Behavioral treatment (lifestyle modification counseling for weight loss) plus placebo
Behavioral treatment (lifestyle modification counseling for weight loss) plus semaglutide
Outcomes
Primary Outcome Measures
Ad libitum energy intake (kcal) during a buffet lunch meal (4 hrs after standardized breakfast)
Primary outcome
Secondary Outcome Measures
Laboratory-based appetite measured as a composite of visual analogue scale ratings (hunger, fullness, satiety, prospective consumption) when fasting and after eating (area under the curve). This is a single outcome calculated by combining the VAS ratings
Secondary confirmatory outcome
Global subjective appetite (e.g., hunger, fullness, food preoccupation) over the past week measured using the Control of Eating Questionnaire (COEQ)
Secondary confirmatory outcome
Explicit responsiveness to the food environment measured by the summary score of the Power of Food Scale (15-item version)
Secondary confirmatory outcome
Implicit food wanting of high-fat, savory foods measured using the Leeds Food Preference Task
Secondary confirmatory outcome
Full Information
NCT ID
NCT05548647
First Posted
September 14, 2022
Last Updated
October 6, 2023
Sponsor
University of Pennsylvania
Collaborators
Novo Nordisk A/S
1. Study Identification
Unique Protocol Identification Number
NCT05548647
Brief Title
Semaglutide Treatment, Appetite, and Eating Behavior: Long-term Effects
Acronym
STABLE Wt Loss
Official Title
Short- and Long-term Effects of Once Weekly Semaglutide 2.4 mg on Appetite, Eating Behavior, and Psychosocial Status
Study Type
Interventional
2. Study Status
Record Verification Date
October 2023
Overall Recruitment Status
Recruiting
Study Start Date
July 26, 2022 (Actual)
Primary Completion Date
July 15, 2025 (Anticipated)
Study Completion Date
July 15, 2025 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University of Pennsylvania
Collaborators
Novo Nordisk A/S
4. Oversight
Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
This study will evaluate the effect of semaglutide on eating behavior, appetite (hunger/fullness), and food liking in the long-term, as compared to placebo. All participants will receive lifestyle modification (diet and exercise) counseling, and will be prescribed the FDA-approved weight loss medication, semaglutide, or placebo (an inactive saline solution) for 72 weeks.
Detailed Description
This trial consists of a single 72-week treatment period during which two studies will be conducted. Study 1 (i.e., long-term treatment trial; weeks 0-60) is a 60-week, single center, double-blinded, randomized controlled, parallel group design trial, and Study 2 (i.e., re-randomized medication withdrawal trial; weeks 60-72) is a separate, 12-week, double-blind, re-randomized medication withdrawal trial.
The long-term treatment trial (Study 1) will randomly assign (in a 3:2 semaglutide:placebo ratio) 120 subjects with a body mass index (BMI) ≥30 kg/m2, or ≥27 kg/m2 with ≥1 obesity-related co-morbidities, to 60 weeks of: 1) placebo with moderate intensity lifestyle intervention (as used in STEP 1); or 2) semaglutide 2.4 mg with the same lifestyle intervention. All subjects will receive 60 weeks of trial product, which will be up-titrated over 16 weeks in those assigned to semaglutide 2.4 mg. They will complete assessments of energy intake, appetite, food reward, mood, symptoms of disordered eating, and anthropomorphic measurements at baseline (week 0) and weeks 20, 40, and 60.
The primary aim in the initial long-term treatment trial will be to compare the long-term effect of semaglutide 2.4 mg vs placebo on ad libitum energy intake during a lunch meal at weeks 20, 40, and 60. Confirmatory secondary aims will test the effect of semaglutide 2.4 mg at weeks 20, 40 and 60 on subjective appetite ratings (both measured during a standardized breakfast in the lab and as experienced more globally over the past week), explicit food reward, as measured with the Power of Food Scale (24), and implicit food reward, as measured with the Leeds Food Preference Task (25, 26). Measures of food cravings, mood, eating disorder symptoms, and self-report measures of eating behavior will be considered supportive secondary endpoints and will provide additional evidence of the medication's safety and efficacy.
Following the completion of Study 1 at week 60, all subjects who complete a week 60 assessment and remain on drug will be enrolled in Study 2. Semaglutide-treated subjects will be re-randomized (in a 1:4 semaglutide:placebo ratio) to receive semaglutide 2.4 mg or placebo for 12 weeks. All subjects originally assigned to placebo will continue with that medication for an additional 12 weeks. Both researchers and subjects will remain blinded to subjects' original and re-randomized (or continued) treatment assignments. The goal of this re-randomized medication withdrawal period will be to compare the 80% of subjects originally assigned to semaglutide 2.4 mg who receive placebo at week 60 (semaglutide-to-placebo group) to the subjects originally randomized to placebo (continuous-placebo group) on all primary and secondary outcome measures at week 72 (after controlling for Study 1 baseline/week 0 values). All subjects will terminate trial product at cumulative week 72 and will return to clinic for a final safety visit at week 76.
Outcome assessments including ad libitum energy intake, subjective measures of appetite, food reward, eating behavior, mood, and eating disorder symptoms will occur at weeks 0, 20, 40, and 60 of Study 1 and at week 12 (72 weeks from original randomization) of the re-randomized treatment period. Measurements of body weight, waist circumference, blood pressure, pulse, and global, past-week appetite and food cravings (COEQ) also will be collected every 4 weeks throughout both treatment studies.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Obesity
Keywords
Semaglutide, Body weight, Obesity, weight loss, medication, overweight, lifestyle modification, diet, exercise, Body Weight Changes, Appetitive Behavior
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Parallel Assignment
Model Description
Study 1 is a double-blind, placebo-controlled, randomized controlled, long-term treatment trial. Study 2 is a double-blind, medication withdrawal trial, re-randomized treatment trial.
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Masking Description
Double-blind
Allocation
Randomized
Enrollment
120 (Anticipated)
8. Arms, Groups, and Interventions
Arm Title
Behavioral Treatment + Placebo
Arm Type
Active Comparator
Arm Description
Behavioral treatment (lifestyle modification counseling for weight loss) plus placebo
Arm Title
Behavioral Treatment + Medication
Arm Type
Active Comparator
Arm Description
Behavioral treatment (lifestyle modification counseling for weight loss) plus semaglutide
Intervention Type
Behavioral
Intervention Name(s)
Behavioral Treatment
Other Intervention Name(s)
Lifestyle modification, Behavioral weight loss, Lifestyle intervention
Intervention Description
All participants, regardless of medication assignment, will receive the same 60-week behavioral weight loss program. Brief (15-minute), individual lifestyle counseling sessions will be delivered by a psychologist, behavioral health counselor, or registered dietitian (or other trained health care provider) at weeks 0 (i.e., baseline/randomization), 2, 4 and every fourth week from week 4 to week 60 (17 sessions) of Study 1. Subjects will be instructed to consume a self-selected diet of 1200-1500 kcal/day (for those who weigh < 250 lb) or 1500-1800 kcal/day (for those who weigh ≥250 lb). They will be instructed to engage in low-to-moderate intensity physical activity (e.g., walking), gradually building to a goal of ≥150 minutes per week (spread across 5 days) by week 40. They will be instructed to use calorie counting and self-monitoring to meet their goals.
Intervention Type
Drug
Intervention Name(s)
Placebo
Other Intervention Name(s)
Placebo for medication
Intervention Description
An inactive saline solution administered via subcutaneous injection
Intervention Type
Drug
Intervention Name(s)
Semaglutide 2.4 MG/0.75 ML Subcutaneous Solution [WEGOVY]
Other Intervention Name(s)
Wegovy
Intervention Description
Semaglutide 2.4 mg is a once weekly subcutaneous glucagon-like peptide-1 (GLP-1) receptor agonist that has been FDA approved for weight loss
Primary Outcome Measure Information:
Title
Ad libitum energy intake (kcal) during a buffet lunch meal (4 hrs after standardized breakfast)
Description
Primary outcome
Time Frame
S1: Change from baseline to weeks 20, 40, and 60; S2: Week 72 endpoint controlling for S1 baseline
Secondary Outcome Measure Information:
Title
Laboratory-based appetite measured as a composite of visual analogue scale ratings (hunger, fullness, satiety, prospective consumption) when fasting and after eating (area under the curve). This is a single outcome calculated by combining the VAS ratings
Description
Secondary confirmatory outcome
Time Frame
S1: Change from baseline to weeks 20, 40, and 60; S2: Week 72 endpoint controlling for S1 baseline
Title
Global subjective appetite (e.g., hunger, fullness, food preoccupation) over the past week measured using the Control of Eating Questionnaire (COEQ)
Description
Secondary confirmatory outcome
Time Frame
S1: Change from baseline to weeks 20, 40, and 60; S2: Week 72 endpoint controlling for S1 baseline
Title
Explicit responsiveness to the food environment measured by the summary score of the Power of Food Scale (15-item version)
Description
Secondary confirmatory outcome
Time Frame
S1: Change from baseline to weeks 20, 40, and 60; S2: Week 72 endpoint controlling for S1 baseline
Title
Implicit food wanting of high-fat, savory foods measured using the Leeds Food Preference Task
Description
Secondary confirmatory outcome
Time Frame
S1: Change from baseline to weeks 20, 40, and 60; S2: Week 72 endpoint controlling for S1 baseline
Other Pre-specified Outcome Measures:
Title
Food cravings over the past week as measured by the COEQ (Three factors: craving control, craving for sweet foods, craving for savory foods)
Description
Supportive secondary outcome
Time Frame
S1: Change from baseline to weeks 20, 40, and 60; S2: Week 72 endpoint controlling for S1 baseline
Title
Food cravings as measured by the General Food Cravings Questionnaire - Trait
Description
Supportive secondary outcome
Time Frame
S1: Change from baseline to weeks 20, 40, and 60; S2: Week 72 endpoint controlling for S1 baseline
Title
Explicit food liking measured during the Leeds Food Preference Task
Description
Supportive secondary outcome
Time Frame
S1: Change from baseline to weeks 20, 40, and 60; S2: Week 72 endpoint controlling for S1 baseline
Title
Eating behavior including cognitive restraint and dietary disinhibition (Eating Inventory)
Description
Supportive secondary outcome
Time Frame
S1: Change from baseline to weeks 20, 40, and 60; S2: Week 72 endpoint controlling for S1 baseline
Title
Weight-related self-efficacy (WEL-short form)
Description
Supportive secondary outcome
Time Frame
S1: Change from baseline to weeks 20, 40, and 60; S2: Week 72 endpoint controlling for S1 baseline
Title
Mood as assessed using the PHQ-9
Description
Supportive secondary outcome
Time Frame
S1: Change from baseline to weeks 20, 40, and 60; S2: Week 72 endpoint controlling for S1 baseline
Title
Symptoms of disordered eating including clinician-rated binge eating frequency (sum of objective and subjective binge eating frequency) as assessed by the Eating Disorder Examination (EDE)
Description
Supportive secondary outcome
Time Frame
S1: Change from baseline to weeks 20, 40, and 60; S2: Week 72 endpoint controlling for S1 baseline
Title
Self-reported loss-of-control eating (Loss of Control Eating Scale [LOCES])
Description
Supportive secondary outcome
Time Frame
S1: Change from baseline to weeks 20, 40, and 60; S2: Week 72 endpoint controlling for S1 baseline
Title
Drive for thinness (Eating Disorder Inventory [EDI])
Description
S1: Supportive secondary outcome
Time Frame
Change from baseline to weeks 20, 40, and 60; S2: Week 72 endpoint controlling for S1 baseline
Title
Ratings of food palatability and of nausea, thirst, and wellbeing fasting and in the 4 hours after consuming the standard breakfast meal
Description
Exploratory outcome
Time Frame
S1: Change from baseline to weeks 20, 40, and 60, and measures at week 72; S2: Week 72 endpoint controlling for S1 baseline
Title
Food addiction measured by Yale Food Addiction Scale
Description
Exploratory outcome
Time Frame
S1: Change from baseline to weeks 20, 40, and 60; S2: Week 72 endpoint controlling for S1 baseline
Title
Body image satisfaction (Body Satisfaction Scale)
Description
Exploratory outcome
Time Frame
S1: Change from baseline to weeks 20, 40, and 60; S2: Week 72 endpoint controlling for S1 baseline
Title
Weight-related self stigmatization by the Weight Bias Internalization Scale
Description
Exploratory outcome
Time Frame
S1: Change from baseline to weeks 20, 40, and 60; S2: Week 72 endpoint controlling for S1 baseline
Title
Body weight (kg)
Description
Supportive secondary outcome
Time Frame
S1: Change from baseline to weeks 20, 40, and 60; S2: Week 72 endpoint controlling for S1 baseline
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
70 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Men and women who report a desire to lose weight
Aged 18-70 years
Body mass index [BMI] ≥ 30 kg/m2 or BMI ≥ 27 kg/m2 with an obesity-related comorbidity (e.g., treated or untreated hypertension, dyslipidemia, obstructive sleep apnea, or cardiovascular disease)
Eligible female patients will be:
non-pregnant, evidenced by a negative urine pregnancy test
non-lactating
surgically sterile or postmenopausal, or they will agree to continue to use an accepted method of birth control during the study
Subjects must
Plan to remain in the Philadelphia area for the next 1.5 years.
Ability to provide informed consent before any trial-related activities.
Exclusion Criteria:
A diagnosis of type I or II diabetes
Hemoglobin A1c (HbA1c) > 6.5%
Uncontrolled hypertension (blood pressure ≥ 160/100 mm Hg)
Clinically significant hepatic (i.e., liver fibrosis, cirrhosis or confirmed NASH) or renal disease
Uncontrolled thyroid disease
Experienced a cardiovascular event (e.g., stroke, myocardial infarction) in the last 6 months, congestive heart failure, or heart block greater than first degree
A history of acute pancreatitis in the last 6 months
Any history of chronic pancreatitis
A history of malignancy (other than non-melanoma skin cancer) within the last 5 years
A personal or family history of medullary thyroid cancer or multiple endocrine neoplasia syndrome type 2
A self-reported change in body weight >5kg (11 lbs) within 90 days before screening
Used within the last 6 months medications known to produce weight loss/gain (e.g., medications approved for weight loss, oral steroids, antipsychotic medications) or any GLP-1 receptor agonist.
Known or suspected allergy or hypersensitivity to trial medication(s), excipients, or related products
The receipt of any investigational drug within 6 months prior to this trial
Applicants with current severe major depressive disorder (BDI-II score ≥ 29 or Patient Health Questionnaire-9 [PHQ-9] score > 15) or severe anxiety disorder
Applicants with current, active suicidal ideation, and/or a suicide attempt within the past year (such individuals will be referred for psychiatric treatment if they have not previously received it).
Any severity of psychotic or bipolar disorder
Bulimia nervosa diagnosis within the past 5 years
Self-reported alcohol or substance abuse within the past 6 months, including at-risk drinking (current consumption of ≥ 14 alcoholic drinks per week)
History of (or plans to receive in the next 1.5 years) bariatric surgery or a weight loss device. (However, the following will be allowed: liposuction or abdominoplasty > 1 year before screening, laparoscopic banding if removed > 1 year before screening, intragastric balloon or aspire assist if removed > 1 year before screening.)
Inability to walk 5 blocks or more (comfortably) or engage in another form of aerobic activity.
Women who are nursing, pregnant, or planning to become pregnant in the next 1.5 years or are not using adequate contraceptive measures
Previous participation in this trial (e.g., randomized but failed to participate)
Changes to any chronic medication (type or dosage) within the past 3 months.
Food allergy or dietary preference that would prevent the individual from consuming the standard breakfast or ad libitum lunch.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Kaitlyn DeRouen, BA, BSEd
Phone
412-293-0957
Email
kaitlyn.derouen@pennmedicine.upenn.edu
First Name & Middle Initial & Last Name or Official Title & Degree
Jena Tronieri, PhD
Phone
215-746-5045
Email
jena.tronieri@pennmedicine.upenn.edu
Facility Information:
Facility Name
University of Pennsylvania Center for Weight and Eating Disorders
City
Philadelphia
State/Province
Pennsylvania
ZIP/Postal Code
19104
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Jena Tronieri, PhD
Phone
215-746-5045
Email
jena.tronieri@pennmedicine.upenn.edu
First Name & Middle Initial & Last Name & Degree
Jena Tronieri, PhD
12. IPD Sharing Statement
Plan to Share IPD
Undecided
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Semaglutide Treatment, Appetite, and Eating Behavior: Long-term Effects
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