{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T03:44:14Z","timestamp":1777866254310,"version":"3.51.4"},"reference-count":30,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:00:00Z","timestamp":1777507200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background: Obesity is a heterogeneous chronic disease in which eating behavior phenotypes may influence treatment response. Yet, anti-obesity medication (AOM) selection is still largely guided by anthropometric and metabolic parameters, with limited use of behavioral phenotyping in routine practice. We evaluated whether multidimensional eating behavior changes, measured by the Brazilian Eating Behavior Phenotype Scale (Escala de Fen\u00f3tipos do Comportamento Alimentar, EFCA), differ across commonly used AOMs in a real-world cohort. Methods: We conducted a retrospective, observational, real-world study in obesity outpatient care settings in S\u00e3o Paulo, Brazil. Adults with obesity (18\u201365 years) treated with a single principal AOM for 6 months and paired baseline\/6-month follow-up EFCA and anthropometric data were included. Analyses focused on early responders (\u22655% total body weight loss at 3 months). Five AOM groups available in Brazil were analyzed: semaglutide (oral or subcutaneous), naltrexone\/bupropion, sibutramine, topiramate, and tirzepatide. Outcomes included percent weight loss, EFCA total score, and five EFCA subscales (hedonic, emotional, compulsive, hyperphagic, disorganized). Within-medication behavioral changes were assessed using paired tests and standardized effect sizes (Cohen\u2019s dz, 95% CI), summarized in heatmap form. Results: The analytical cohort comprised 66 early responders with paired EFCA assessments at baseline and 6 months. EFCA profiling revealed distinct behavioral response fingerprints across AOMs. Effect size mapping showed predominantly large behavioral effects (many dz \u2265 0.8) in hedonic, emotional, hyperphagic, and compulsive domains. Strongest signals included emotional eating reductions with naltrexone\/bupropion (dz 2.04), tirzepatide (dz 1.77), semaglutide (dz 1.52), and topiramate (dz 1.54); hedonic reductions with tirzepatide (dz 2.06), semaglutide (dz 1.55), and naltrexone\/bupropion (dz 1.52); hyperphagic reductions with tirzepatide (dz 1.50) and semaglutide (dz 1.34); and compulsive reductions with topiramate (dz 1.41) and consistent effects across tirzepatide, semaglutide, and sibutramine (\u2248dz 0.95\u20130.96). Disorganized eating showed heterogeneous\/attenuated responsiveness, from near-null with tirzepatide (dz 0.03) to large but imprecise effects in smaller groups (e.g., topiramate dz 1.24, wide CI). Conclusions: In this responder-enriched real-world cohort, AOMs showed distinct and reproducible EFCA behavioral signatures, supporting a clinically actionable phenotype-informed framework to prioritize, sequence, and monitor obesity pharmacotherapy beyond nonspecific weight reduction, while highlighting disorganization as a potential target for adjunctive behavioral strategies.<\/jats:p>","DOI":"10.3390\/nu18091419","type":"journal-article","created":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T08:03:47Z","timestamp":1777536227000},"page":"1419","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Toward Precision Obesity Pharmacotherapy: Using the Eating Behavior Phenotype Scale (EFCA) in Real-World Clinical Practice"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7582-5179","authenticated-orcid":false,"given":"Ronaldo Jos\u00e9","family":"Pineda-Wieselberg","sequence":"first","affiliation":[{"name":"Discipline of Endocrinology, Santa Casa de Miseric\u00f3rdia de S\u00e3o Paulo, S\u00e3o Paulo 01221-020, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andressa Heimbecher","family":"Soares","sequence":"additional","affiliation":[{"name":"Discipline of Endocrinology, Santa Casa de Miseric\u00f3rdia de S\u00e3o Paulo, S\u00e3o Paulo 01221-020, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-6233-3408","authenticated-orcid":false,"given":"Thiago Fraga","family":"Napoli","sequence":"additional","affiliation":[{"name":"Discipline of Endocrinology, Santa Casa de Miseric\u00f3rdia de S\u00e3o Paulo, S\u00e3o Paulo 01221-020, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nilza Maria","family":"Scalissi","sequence":"additional","affiliation":[{"name":"Discipline of Endocrinology, Santa Casa de Miseric\u00f3rdia de S\u00e3o Paulo, S\u00e3o Paulo 01221-020, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jo\u00e3o Eduardo Nunes","family":"Salles","sequence":"additional","affiliation":[{"name":"Discipline of Endocrinology, Santa Casa de Miseric\u00f3rdia de S\u00e3o Paulo, S\u00e3o Paulo 01221-020, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"The Lancet Diabetes & Endocrinology (2025). 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