Obesity Pharmacotherapy is Effective in the Veterans Affairs Patient Population: A Local and Virtual Cohort Study

Abstract

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.

Prevalence, risk factors, and interventions for obesity in Saudi Arabia: A systematic review

“…77 , 78 In the first study, liraglutide treatment mitigated the expected weight gain in this cohort who were also being treated with insulin, and 12‐month weight change was nonsignificantly different from baseline, 77 and in the second study, 12‐week weight loss in treatment naïve patients averaged 3.9 kg (4.2%). This response to liraglutide mirrors other real‐world studies, 79 but of note, the dose was lower than that currently advocated for obesity, and newer formulations of GLP‐1R agonists are likely to be even more potent. Neither study documented side effects.…”

Obesity among Latinx people in the United States: A review

“…In phase 3 trials evaluating the efficacy of semaglutide or phentermine‐containing AOMs, the proportion of Latinx participants was low (12%–20%) [ 52 , 53 , 54 , 55 ], highlighting a need for more data in the Latinx population. As with the general population [ 56 ] and veteran population [ 57 ], determining obesity phenotypes within the Latinx population may help to enhance weight loss and minimize variability in AOM response.…”

Obesity treatment initiation, retention, and outcomes in the Veterans Affairs MOVE! Program among rural and urban veterans

“…Additionally, the cohort consists only of veterans with obesity class II or III, which may increase the likelihood of medication use 13 . Factors contributing to low levels of anti‐obesity medication use include inadequate physician training, VA formulary restrictions, high rates of comorbidities and contraindications to use, concerns about safety and efficacy, and limited patient‐provider time 11,12,37 . Additionally, some clinicians may believe that obesity is a behavioral problem not warranting medication 37 …”

“…treatment may include pharmacotherapy or bariatric surgery when behavioral treatment alone is insufficient. [11][12][13][14][15] Overall, veterans' participation in MOVE! is low, with rates ranging from 10% to 13% over periods of 5-8 years among eligible veterans with overweight or obesity.…”

“…treatment may include pharmacotherapy or bariatric surgery when behavioral treatment alone is insufficient. 11 , 12 , 13 , 14 , 15 …”