Introduction: Obesity is a complex metabolic condition associated with significant cardiometabolic risks. The Comprehensive Metabolic Therapy (CoMeT) programme is a multidisciplinary intervention designed to address these risks through integrated medical management, physiotherapy, and dietary counseling. This pilot study aimed to evaluate the effectiveness of the CoMeT programme on anthropometric, metabolic, and body composition parameters in adults with obesity. Methodology: We conducted a pilot pre–post study involving 11 adults with obesity (BMI ≥27.5 kg/m²) enrolled in the CoMeT programme at Hospital Putrajaya. Assessments at baseline and post-intervention included anthropometric measures (weight, BMI, waist circumference), metabolic parameters (hemoglobin A1c [HbA1c]), and body composition (skeletal muscle mass [SMM], body fat percentage) using InBody 970 bioelectrical impedance analysis. Data were analyzed using SPSS version 29.0. Results: The mean age was 38.5 ± 8.9 years, with baseline weight 134.7 ± 20.9 kg and BMI 49.8 ± 9.0 kg/m². Three participants defaulted follow-up, leaving eight for post-intervention analysis. The mean weight reduction was 2.1 ± 6.4 kg (1.6 ± 5.0%). Notably, the greatest reduction (−12.5%) occurred in a participant with high adherence to both the dietary and physiotherapy components of the intervention. Participants receiving GLP-1 receptor agonists (oral semaglutide) also demonstrated weight reduction (mean −2.5 kg). Conversely, weight gain was observed in some participants despite diet modifications, potentially due to low physiotherapy attendance or baseline metabolic factors. HbA1c improved modestly (−0.19 ± 0.29%). Body composition changes were minimal, with slight reductions in body fat percentage (−0.13 ± 1.2%) and SMM (−0.49 ± 1.88 kg). Conclusion The CoMeT programme shows promising early-stage effectiveness in improving anthropometric and metabolic outcomes with the greatest benefits observed in patients achieving high multidisciplinary adherence and adjunct pharmacotherapy. These findings highlight the potential of a multidisciplinary approach in managing high-grade obesity and emphasize the need for larger-scale studies to further validate these outcomes and optimize targeted lifestyle and therapeutic interventions
Body Composition ; Adult ; Obesity

Introduction: The growing popularity of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) for weight management has inadvertently perpetuated demand for unregulated experimental peptides procured through gray markets. Retatrutide, a novel triple GLP-1/glucose-dependent insulinotropic polypeptide (GIP)/glucagon receptor agonist undergoing Phase III trials; AOD -9604, an abandoned synthetic human growth hormone fragment; and tesamorelin, a synthetic GHRH analogue, are increasingly self-administered without medical supervision. Their combined metabolic and thromboembolic risks remain unknown and unreported. Case: A 50-year-old Malaysian female with morbid obesity and poorly controlled type 2 diabetes mellitus (hemoglobin A1c 13%) presented with acute dyspnea, chest tightness, syncope, and cardiogenic shock. Three weeks prior, she had self-initiated subcutaneous retatrutide, AOD-9604, and tesamorelin procured through unregulated online platforms, achieving rapid weight loss of 10 kg. Despite markedly reduced oral intake from GLP-1-mediated gastrointestinal side effects, she continued her prescribed high-dose insulin regimen and sodium-glucose cotransporter-2 (SGLT2) inhibitor without dose adjustment. She developed concurrent diabetic ketoacidosis, confirmed biochemically, alongside massive saddle pulmonary embolism with right ventricular strain on echocardiography and computed tomography pulmonary angiography. She was successfully treated with systemic thrombolysis using alteplase, guideline-directed diabetic ketoacidosis management including fixed-rate insulin infusion and fluid resuscitation, and anticoagulation. The SGLT2 inhibitor was withheld throughout admission. She was discharged on rivaroxaban with counseling to cease all unregulated compounds. All three agents were submitted to the National Pharmaceutical Regulatory Authority/Malaysian Adverse Drug Reactions Advisory Committee for adverse drug reaction reporting. Conclusion To our knowledge, this is the first reported case of concurrent massive pulmonary embolism and diabetic ketoacidosis precipitated by unsupervised gray-market retatrutide, AOD-9604, and tesamorelin. Clinicians should enquire about unregistered supplement use, counsel insulin-dependent patients on sick-day rules when appetitesuppressing agents are initiated, and report adverse events to pharmacovigilance authorities.
AOD 9604 ; tesamorelin ; Diabetic Ketoacidosis ; Pulmonary Embolism ; Peptides