Objective: Obesity is a major public health challenge, and the US military veteran population is disproportionately affected. Using deidentified records from a local weight management clinic and a national clinical data repository, obesity pharmacotherapy use and effectiveness for weight loss and obesity comorbidities in this vulnerable population were assessed. Methods: During the initial year of the local clinic, 43 records with monthly follow-up of MOVE! lifestyle intervention augmented by obesity pharmacotherapy were found. Nationally, more than 2 million records of prescribed obesity pharmacotherapy compared with metformin as control were identified. Records with detailed documentation of weight trends from 1 year before to 1 year after the prescription date for further analysis were selected for review. Results: The most commonly prescribed medications in the local clinic were metformin, liraglutide, and combination phentermine/topiramate. On average, weight loss of −4.0 ± 2.1 kg over the initial 6-month intervention was observed. In the national cohort, 577,491 records with an obesity or control metformin prescription and adequate weight documentation were identified. The most effective pharmacotherapy in the national cohort was phentermine/topiramate (−0.0931 ± 0.0198 kg/wk difference), followed by liraglutide, lorcaserin, and orlistat. Conclusions: Obesity pharmacotherapy is effective in achieving clinically meaningful weight loss in veterans as part of an integrated care approach.

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Background: Overweight and obesity are major health burdens in veterans, occurring at higher rates than the general population (78% vs 69%) and associate with chronic disease development. Self-efficacy is a person's ability to overcome the difficulties inherent in performing a specific task in a particular situation such as smoking cessation. We evaluated if a simple self-efficacy score may serve as a predictor of weight control in de-identified records of veterans with obesity undergoing a weight loss intervention consisting of lifestyle modification with pharmacotherapy through a VA weight management clinic. Methods We reviewed deidentified records for 22 obese (BMI ≥ 30) participants (17 males, 5 females, age range = 43–69, race/ethnicity 45% Black, 32% White, 18% Latino, and 5% Asian) in the VA weight management clinic. As part of the intake assessment, we used 2 validated questions to assess participants’ confidence in their ability to lose weight. Individuals were asked: “How ready are you to commit time, energy and resources to weight loss therapy?" and "How confident are you in your ability to lose weight?" Answers were rated from 1 (not ready or not confident) to 3 (ready or confident). Self-efficacy was scored as high (5-6), intermediate (3-4) or low (0-2). Results: Participants were on average 56 years old with weight of 275±49 lb at baseline. Eight records were classified as having high self-efficacy, 7 had moderate self-efficacy, and 3 had low self-efficacy. After 3 months of lifestyle plus pharmacotherapy intervention, weight loss in the high self-efficacy group was 8.8 ± 4.6 lb vs -0.4 ± 1.2 lb (mean±SE, p = 0.088) in the non-high self-efficacy group. Excess body weight in high vs non-high self-efficacy groups at 3 months was 3.08% ± 0.02% vs -0.26% ± 0.01 (p = 0.094). Conclusions: Our data suggests that veterans with obesity and high self-efficacy may lose more weight than those with lower self-efficacy. This simple tool may serve as an important first screen for weight management clinical practice. References -Diabetes Prevention Program Research, G., et al., 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. Lancet, 2009. 374(9702): p. 1677-86. -Tsai et al. Readiness Redefined: A Behavioral Task during Screening Predicted 1-Year Weight Loss in the Look AHEAD Study. Obesity (Silver Spring). 2014 April ; 22(4): 1016–1023. doi:10.1002/oby.20648.