DOI: 10.4103/jehp.jehp_2134_25 ISSN: 2277-9531

Pharmacological therapy and dietary intervention for obesity management: A one-year prospective cohort study in Baghdad

Duaa Mohammed Al-Atta, Sura Talal Kadhim, Monaf Faik Al-Samarraee
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BACKGROUND:

Evidence directly comparing long-term pharmacological therapy and structured dietary intervention for obesity in Middle Eastern populations is limited. This study provides 12-month real-world comparative data from specialized obesity clinics in Baghdad, Iraq.

MATERIALS AND METHODS:

A prospective cohort study included 120 adults with obesity (BMI ≥30 kg/m 2 ) from June 2024 to June 2025. Participants received either pharmacological therapy (orlistat 120 mg three times daily or liraglutide 3.0 mg/day; n = 60) with standard lifestyle advice, or intensive individualized dietary counseling by board-certified dietitians ( n = 60). The primary outcome was percentage weight loss at 12 months. Secondary outcomes assessed body composition, metabolic parameters, physical activity, adherence, adverse effects, and quality of life. Between-group differences were analyzed using independent t-tests with exact P values and 95% confidence intervals.

RESULTS:

At 12 months, pharmacological therapy associated with greater early weight loss but reached a plateau (13.5 ± 3.7% vs. 11.3 ± 4.3%, P < 0.001; 95% CI: 1.1–2.8%). Dietary intervention associated with higher fat-mass loss (68.9% vs. 53.1%, P < 0.001), better lean-mass preservation ( P = 0.003), and superior improvements in LDL-cholesterol ( P = 0.012), fasting glucose ( P = 0.047), systolic blood pressure ( P = 0.041), and physical activity ( P = 0.001). Adherence (73.3% vs. 58.3%, P = 0.038) and patient satisfaction ( P < 0.001) were higher with diet, while gastrointestinal side effects were more common with pharmacotherapy (68.3% vs. 11.7%, P < 0.001).

CONCLUSIONS:

Intensive dietary counseling yielded to superior long-term metabolic, behavioral, and patient-centered outcomes with better adherence, supporting its use as a first-line obesity treatment. Pharmacological therapy may be an adjunct for selected patients, highlighting the importance of structured, dietitian-led lifestyle programs within health systems.

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