Access to obesity medications boosts weight loss in employer-based program
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Adults with obesity participating in a real-world, employer-based weight-management program were significantly more likely to achieve clinically meaningful weight loss when adding pharmacotherapy to shared monthly visits, data show.
“Many health care providers are reluctant to prescribe anti-obesity medications to treat obesity,” Bartolome Burguera, MD, PhD, chair of the Cleveland Clinic Endocrinology and Metabolism Institute, told Healio. “We had retrospective data showing our weight-management program was successful in helping people to achieve 5% weight loss; however, we did not have solid data on the additive benefits of medication. Sometimes, it is difficult to extrapolate data from these very selective [anti-obesity drug] trials. This was a pragmatic, real-life study with Cleveland Clinic employees.”
Burguera and colleagues analyzed data from 200 adults with obesity who were enrolled in the Cleveland Clinic Employee Health Plan from Jan. 7, 2019, to May 22, 2020 (177 women; mean age, 50 years; mean baseline weight, 105 kg). Researchers randomly assigned participants to a weight-management program combined with an anti-obesity medication (n = 100) or to a weight-management program without pharmacotherapy (n = 100). The weight-management program was implemented through monthly multidisciplinary shared medical appointments. Participants in the pharmacotherapy group initiated treatment with one of five FDA-approved medications for chronic weight management: orlistat (Alli, GlaxoSmithKline), lorcaserin, phentermine/topiramate (Qsymia, Vivus), naltrexone/bupropion (Contrave, Nalpropion Pharmaceuticals) and liraglutide 3 mg (Saxenda. Novo Nordisk), according to standard clinical practice.
The primary endpoint was the percentage change in body weight from baseline to 12 months.
For the primary intention-to-treat estimand, the estimated mean weight loss was –7.7% for the weight-management program with pharmacotherapy vs. –4.2% for the weight-management program without pharmacotherapy group, with an estimated treatment difference of –3.5 percentage points (95% CI, –5.5 to –1.5). The estimated percentage of participants achieving at least 5% weight loss was 62.5% for the weight-management program plus pharmacotherapy group vs. 44.8% for participants in the program without pharmacotherapy (P = .02).
The rate of attendance at shared medical appointments was also higher for those in the program that included pharmacotherapy vs. the program without medication.
Researchers did not observe any meaningful differences in patient-reported work productivity or limitation measures.
“We were happy to see that adding pharmacotherapy has a very significant impact in improving weight loss,” Burguera said. “We were also surprised with the adherence level. People who participated in the study thought the program was worth it. The medications were helpful, regardless of which one we used.”
The researchers wrote that the findings address a “critical gap in evidence” in the real-world effectiveness of anti-obesity medications in employer-based settings, adding that the data show the weight loss achieved by adding pharmacotherapy to shared medical appointments can yield clinical benefits similar to those seen in randomized controlled trials.
“Obesity is a disease that needs to be treated aggressively with all the tools we have available,” Burguera told Healio. “Some people can lose significant weight improving their diet and becoming more active. In many circumstances, the changes that occur in the body prevent weight loss. Medications help lower the set point of appetite. You make the [lifestyle] changes, and your brain, because you are taking the medication, allows you to be at that lower set point.”
As Healio previously reported, data from Burguera and colleagues published in Obesity Science and Practice in January 2020 showed that shared medical appointments may offer a favorable strategy for obesity management with greater weight loss and more access to anti-obesity medications compared with individual medical visits alone. The average weight loss at 1 year was 5.2% in the shared appointments group and 1.8% in the individual appointments group (paired t test, P < .05). Additionally, weight-loss proportions of 5% and higher from baseline were also greater in the shared appointments group (44.7%) vs. the individual appointments group (31.4%), according to the researchers.
Perspective
Back to TopScott Kahan, MD, MPH; Adriana Williams, MD
Losing weight is rarely easy. Losing a lot of weight, let alone managing to keep it off over time, is most often extremely challenging. We are fighting against genetics, physiology, unhealthful environments, ingrained habits and often stressful logistics of life — be it long work hours, kids or COVID-19.
To expect a simple solution to cure this complex and multidimensional problem is unrealistic. Diet, an exercise plan, counseling, a medication or even surgery are often insufficient on their own; however, numerous studies have shown that combining therapeutic options have a much higher likelihood of benefit.
This study adds further weight to the importance of bundling treatment approaches. Despite fairly infrequent counseling by way of group sessions, those assigned to counseling in conjunction with FDA-approved medication lost twice as much weight as those treated with counseling alone. Moreover, prior studies have shown that adding additional treatments alongside these would further increase the expected weight loss (Wadden TA, et al. Arch Intern Med. 2001; doi:10.1001/archinte.161.2.218).
At this point, there is little justification for weight loss strategies that fail to offer sufficient and overlapping therapeutic levers.
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