Exploring Cardiometabolic Health, Physical Activity, and Quality of Life in Patients with Obesity and Multimorbidity during an Intensive Weight Loss Program: A Protocol for a Real-Life Prospective Cohort Study

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Abstract
Background Obesity is associated with increased risk of morbidity, reduced quality of life, and pervasive weight stigma. For patients with severe obesity and multimorbidity who are ineligible for bariatric surgery, effective treatment options remain limited. Recently, glucagon-like peptide 1 receptor agonist-based weight loss medications have shown promise in weight management, but their effects in highly complex patient populations are not well described. Objective This protocol outlines a prospective observational study designed to explore and describe changes in cardiometabolic health, physical activity, physical capacity, and wellbeing among patients with obesity and multimorbidity enrolled in a two-year intensive weight loss program with GLP-1RA medication. Methods The study uses an exploratory prospective longitudinal cohort design and is based on an intensive weight loss program for patients with obesity and multimorbidity at Copenhagen University Hospital - Hvidovre. Approximately 35 patients will be enrolled over a six-month period. Data are collected at baseline, four months, and 24 months. Key outcomes include objectively measured physical activity, health-related quality of life, and 10-year cardiovascular risk. Additional outcomes include anthropometrics, mental health-related quality of life, weight bias internalization, cardiorespiratory fitness, lower body strength, and walking capacity. Data will be analyzed descriptively, and changes will be reported as mean differences with 95% confidence intervals. The study was registered at clinicaltrials.gov prior to recruitment (NCT06234111). Perspectives This study will provide novel insights into the health effects of intensive GLP-1RA-based weight loss program for patients with severe obesity and multimorbidity ineligible for bariatric surgery, thereby addressing an important knowledge gap in obesity management. Registration https://clinicaltrials.gov/study/NCT06234111

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