Adherence to anti-obesity drugs, engagement with behavioral programs key to weight loss
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Key takeaways:
- Anti-obesity medication users achieved more weight loss vs. nonusers.
- There were no differences in weight loss with delayed or earlier anti-obesity medication initiation.
SAN ANTONIO — Adherence to anti-obesity medications and engagement in intensive behavioral programs are key to higher sustained and categorical weight loss, according to findings from analyses presented at ObesityWeek.
“The reality is this is a therapy that will change the way we approach many chronic diseases that is widely popular and that has led a bunch of new entrants into how we dispense these, and we do need help scaling obesity treatment, and innovation is welcome, but with that innovation, we really have to ask ourselves how we’re going to evaluate quality and how we’re going to know what we’re going to pay for,” Rami Bailony, MD, co-founder and CEO of Enara Health, said during the presentation. “So, real-world data starts to matter much more.”
Bailony and colleagues evaluated 1,282 participants with a BMI of 30 kg/m2 or more enrolled for at least 18 months in Enara Health’s digital obesity program. Researchers stratified participants by whether they were anti-obesity medication users or nonusers, whether their medication use was early (within 2 months of enrollment) or delayed, whether they used their medication short term (< 48 weeks) or longer and whether they used a first- or second-generation anti-obesity medication.
Researchers conducted an intention-to-treat analysis and completer analysis of digital completers who logged weights or checked into an app-based module and care completers who had a visit within 6 weeks. The intervention included a virtual approach to obesity care involving nutrition, exercise and medical and behavioral specialists from cardiology, obesity and primary care sites with online education and remote patient engagement.
The primary outcomes were percentage weight change at 72 weeks from baseline and the proportion of participants who achieved 5%, 10%, 15% and 20% weight loss from baseline.
Overall, 51% of participants chose to use an obesity medication.
For the non-anti-obesity medication group, 64% were digital and 37% were care completers. For the anti-obesity medication group, 78% were digital and 58% were care completers, of which 71% were second-generation users and care completers. Sixty percent of anti-obesity medication users started medication at enrollment and 49% were long-term users.
Anti-obesity medication users were more likely to be women (74% vs. 69%), have a higher BMI (38 kg/m2 vs. 36 kg/m2) and have higher fasting insulin (15.6 U/mL vs. 13.4 U/mL).
Intention-to-treat weight loss was 11.75% vs. 9.99% for anti-obesity medication users and nonusers, respectively (P < .001), and completer analysis demonstrated more weight lost among completers (14.42% vs. 12.77%; P = .02).
Long- vs. short-term users achieved 50% more weight loss (P < .001), but no statistical difference was noted between nonusers and short-term users. Anti-obesity medication users achieved higher weight-loss milestones, with 90% achieving 5%, 76.2% achieving 10%, 52.1% achieving 15% and 30% achieving 20% weight loss. Among long-term anti-obesity medication users, those taking a second-generation medication were more likely than those taking a first-generation medication to achieve 20% weight loss (40.8% vs. 25.5%; P = .018), according to the researchers.
Bailony noted that there were no differences between early or delayed anti-obesity medication initiation.
“When we see patients, there is the weight-loss goal, but ultimately, there are other goals around exercise and quality of life that go well beyond weight loss,” Bailony said. “What we need to think about is, what is our overall approach to holistic health and well-being? What does that overall care model look like? How can anti-obesity medications enable people to make those changes? Because, ultimately, everyone wants to make changes, there are just a lot of biological obstacles to making those changes and when you give them the tools, they’re able to do that.”
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Bailony R, et al. Oral-083. Presented at: ObesityWeek; Nov. 3-6, 2024; San Antonio.
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