Presentation (CTI)

OBJECTIVES: The emergence of GLP-1 receptor agonists has transformed obesity treatment, necessitating comprehensive frameworks to guide clinical practice. Mozaffarian et al.'s (2025) joint advisory outlines seven key stages in GLP-1 therapy: patient-centred initiation, baseline nutritional assessment, management of gastrointestinal side effects, navigation of dietary preferences, prevention of nutrient deficiencies, preservation of muscle/bone mass, and promotion of supportive lifestyle measures. However, the deployment of patient-reported outcome measures (PROMs) across these stages remains unmapped. We examined how current PROMs align with this framework and identified critical measurement gaps.
METHODS: We systematically mapped validated obesity-specific PROMs against Mozaffarian et al.'s GLP-1 treatment framework, categorising their roles as: (1) evaluation tools for treatment effects; (2) screening/stratification instruments; (3) implementation feedback loops; and (4) equity gap identifiers. For each framework stage, we assessed PROM availability, validation status, and development needs. Instruments evaluated included established obesity PROMs (IWQOL-Lite-CT, BODY-Q), symptom measures (PRO-CTCAE), behavioural tools (PHQ-9, GAD-7, BES), and nutritional screeners (Mini-EAT, Diet Risk Score).
RESULTS: Major gaps emerged across all four PROM roles. As evaluation tools: no validated GLP-1-specific symptom inventories exist for gastrointestinal effects or food aversions; measures for "food noise" and hedonic shift remain undeveloped; patient-defined success metrics lack standardisation. As screening instruments: nutritional risk assessment tools inadequately capture protein adequacy or sarcopenia risk; behavioural readiness measures miss GLP-1-specific barriers. Implementation feedback loops are absent for group medical visits, dietitian counselling effectiveness, and Food-is-Medicine program satisfaction. Equity-focused PROMs addressing cultural congruence, discrimination, and financial toxicity in GLP-1 access are entirely missing. Critical gaps include measures for emerging phenomena (satiety-driven identity changes, loss of food pleasure) and tools validated for diverse populations and off-label use scenarios.
CONCLUSIONS: Current PROMs inadequately support the multifaceted roles required in comprehensive GLP-1 obesity care. Strategic PROM deployment requires new instruments spanning symptom monitoring, behavioural assessment, implementation evaluation, and equity tracking.