Effect of Obesogenic Medication on Weight‐ and Fitness‐Change Outcomes: Evidence from the Look AHEAD Study

Abstract

Objective This study evaluates whether obesogenic medications may decrease the effectiveness of lifestyle interventions. The authors of this study hypothesized that participants who took obesogenic medications would be less responsive to the intervention in the Look AHEAD trial. Methods In the trial, 5,145 participants with overweight or obesity, aged 45 to 76 years with type 2 diabetes, were randomly assigned to an intervention (vs. support and education). In this analysis, the association of exposure to obesogenic medications and successful weight loss (≥5% and ≥10% of total weight) and fitness gain (≥1 and ≥2 metabolic equivalents) was examined. For each outcome, multiple logistic regression models were fitted. Results Analytic sample sizes were 4,496 for weight‐change analyses and 4,051 for fitness‐change analyses. After adjusting for covariates, exposure to one or more obesogenic medications significantly decreased the odds of achieving ≥5% weight loss by 32% (odds ratio [OR] 0.68) and achieving ≥10% weight loss by 19% (OR 0.81). The association was dose‐dependent—participants using two or more medications were less likely to achieve weight loss than those using one medication. Obesogenic medication exposure was not associated with decreased odds of achieving fitness gain overall. Conclusions The results suggest that exposure to obesogenic medications could hinder successful weight loss in a lifestyle intervention for people with diabetes.

Socioeconomic status and use of obesogenic and anti-obesity medications in the United States: A population-based study

“… 11 Use of obesogenic medications is associated with lower chance of achieving successful weight loss after both behavioral interventions and bariatric surgery and may contribute to the obesity epidemic. 9 , 10 , 24 , 29 , 30 In response to these data, the Endocrine Society Clinical Practice Guidelines recommend leptogenic medications (i.e., medications that promote weight loss) and weight-neutral medications as alternatives to obesogenic medications for people with overweight or obesity. 11 However, our results showed that almost 40% of people with overweight or obesity took at least one obesogenic medication, even when there were non-obesogenic alternatives.…”

Evidence‐based weight loss interventions: Individualized treatment options to maximize patient outcomes

“…Some medications are well known to produce weight gain, including antidiabetic and antidepressant drugs 17 . In the Look AHEAD study, if patients were exposed to one or more of these obesogenic medications then the probability of achieving a weight loss of greater than 5% was reduced by 32% 80 . If the patient interview identifies one or more of the drug classes listed in Table 2 then the healthcare provider can review the possibility of switching to drugs that have the least adverse effect on weight 17 …”