SUN-675 Very Low Energy Ketogenic Therapy In Combination With Liraglutide As A Synergic Strategy For The Treatment Of Obesity: A Real-world Clinical Evaluation

Abstract Disclosure: E. Camajani: None. C. Camilla: None. M. Spizzichini: None. D. Masi: None. R. Rebecca: None. M. Spoltore: None. C. Lubrano: None. L. Gnessi: None. C.G. Moretti: None. M. Caprio: None. M. watanabe: None. Obesity is a complex condition influenced by a combination of genetic, environmental, and behavioral factors, and it significantly impacts overall health. The management of obesity requires an integrated approach, with dietary therapy as its cornerstone. Among nutritional strategies, the Very Low Energy Ketogenic Therapy (VLEKT) has gained attention for its ability to induce rapid weight loss while minimizing lean mass loss and enhancing satiety. However, for many patients, dietary interventions alone often fall short in achieving sustainable long-term results. In this context, GLP-1 receptor agonists have demonstrated efficacy in reducing and maintaining body weight through appetite modulation and improved glycemic control long term.This single-center, prospective observational study evaluated the efficacy and safety of VLEKT alone (VLEKT group) compared to its combination with liraglutide (VLEKT +Lira group) over a four-month observation period.All participants followed a VLEKT with meal replacements for at least 45 days. The nutritional intervention provided approximately 800 kcal/day, consisting of 4-5 meal replacements daily and one serving of low glycemic index vegetables at lunch and dinner. The macronutrient composition was as follows: carbohydrates <50 g daily, protein 1.2-1.5 g/kg of ideal body weight, and fat comprising the remainder of the calorie intake. Meal replacements were then gradually replaced by protein dishes primarily made of egg, lean meat, and fish. Fats were primarily derived from extra virgin olive oil, fish, and seeds. Calorie intake was gradually increased up to approximately 1200 kcal/daily.Participants in the VLEKT+Lira group were prescribed liraglutide in addition to the dietary intervention. The initial dose was 0.6 mg daily, which was gradually uptitrated based on individual patient tolerance. Dose adjustments were made under close medical supervision to ensure safety and optimize treatment efficacy.Both strategies resulted in significant reductions in body weight and improvements in metabolic parameters. However, the VLEKT +Lira group experienced greater weight loss (-20.4% vs -14.7%, p = 0.013) and a more pronounced reduction in insulin resistance (p<0.001). Ketone levels were higher in the combination group, suggesting improved adherence to the dietary regimen. Despite the metabolic benefits, the VLEKT +Lira group reported a higher incidence of adverse effects, including nausea (p<0.001), heartburn (0.004), reflux (p=0.009), and mental and physical fatigue (p=0.003 and p=0.02, respectively). Safety parameters, including liver enzymes and renal function, remained stable in both groups.These findings suggest that the combination of VLEKT and obesity medications represents an effective strategy for obesity management, although the increased incidence of adverse effects needs careful clinical monitoring. Presentation: Sunday, July 13, 2025