SAT-720 - Weight Loss and Improvements in Cardiometabolic Markers: A 24-Month Longitudinal Analysis of a Digital Metabolic Reset Program

Background: Although weight loss is often the primary goal in obesity management, an exclusive focus on weight can obscure other meaningful improvements in cardiometabolic health. To address this gap, the current study evaluates not only total body weight loss (TBWL) but also the prevalence of metabolic normalization across key biomarkers, including glycated hemoglobin (HbA1c), lipid profiles, and liver function tests (LFTs), within a digital metabolic reset program. We hypothesized that participants would demonstrate high rates of cardiometabolic normalization in addition to weight loss. We also examined the association between program engagement and these outcomes.

Methods: A longitudinal analysis was conducted on participants (N = 1,921; 81.1% female; 78.3% White; 73.3% aged ≥ 46 years) enrolled in a comprehensive digital program combining GLP-1 pharmacotherapy with intensive lifestyle intervention (ILI). Key cardiometabolic biomarkers, including % total body weight loss (%TBWL), HbA1c, lipid panels, and liver function tests (LFTs), were assessed at baseline and 24 months. Regression models were used to evaluate the association between program engagement and these outcomes. Engagement was operationalized as a composite score incorporating coaching attendance and the logging of high-calorie / low-nutrient-density ("red") foods, sleep, and self-reported energy levels, and was categorized from low to high.

Results: Participants achieved a mean %TBWL of 19.1% and 77% normalized at least one cardiometabolic marker by 24 months. Notably, among those with abnormal baseline HbA1c (≥5.7%), 81% achieved normalization ( < 5.7%) within 24 months. Additionally, 91% of participants achieved normalization of AST, while 84% achieved normalization of ALT. With the exception of LDL cholesterol (24%), all other biomarkers normalized in substantial proportions of the sample (64-78%). Regression analyses showed that participants with high engagement achieved significantly greater %TBWL and improvements in HbA1c and insulin levels compared to those with low engagement (all ps < .05). However, no significant differences were observed across engagement groups for other cardiometabolic biomarkers.

Conclusion: These findings demonstrate that substantive improvements in key cardiometabolic markers can be achieved alongside substantial weight loss for the majority of participants in a comprehensive digital metabolic reset program over 24 months. High rates of biomarker normalization underscore the potential of a multi-pillar approach that combines GLP-1 pharmacotherapy with intensive lifestyle intervention. These results also suggest that higher program engagement may enhance weight loss and improvements in HbA1c and insulin levels at 24 months.

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