Weight management treatments remain underused despite their effectiveness

Key takeaways:

• Bariatric surgery offered the greatest probability of 1-year weight loss of 5% or greater, at 93%.
• Researchers noted that efforts to achieve 5% or greater weight loss should focus on initial uptake of treatment.

Several weight management treatments greatly improved the odds of 5% or greater weight loss within a year, but only a small number of patients with obesity use them, researchers found.

According to James Henderson, PhD, an assistant research scientist at the University of Michigan, and colleagues, there are multiple weight management treatments (WMTs) that can help produce 5% or greater weight loss, such as bariatric surgery, injectable antiobesity medications, nutrition counseling and very low-calorie meal replacement.

“However, less than 5% of eligible individuals receive these WMT, and little is known about their clinical potential to support weight loss among individual patients and populations,” they wrote in JAMA Network Open.

In a retrospective, population-based cohort study, the researchers analyzed the electronic health records of 146,959 primary care patients (mean age, 49 years; 56.9% women) who had weight measurements taken in 2017 or 2019. The cohort was eventually narrowed down to 138,682 patients, and among those, obesity prevalence increased from 39.2% in 2017 to 40.7% in 2019, whereas WMT use among patients with obesity increased from 5.3% to 7.1%.

The researchers included 10,180 patients in multistate Markov model that was used to assess associations between WMT and longitudinal weight status trajectories. In that model, 1-year probability of 5% or greater weight loss without WMT was 15.6% (95% CI, 14.3%-16.5%). In comparison, the 1-year probability of 5% or greater weight loss was:

• 23.1% (95% CI, 21.3%-25.1%) with nutrition counseling;
• 27.8% (95% CI, 25%-30.5%) with antiobesity medications;
• 54.6% (95% CI, 46.5%-61.3%) with meal replacement; and
• 93% (95% CI, 89.7%-95%) with bariatric surgery.

Henderson and colleagues explained that efforts to help patients achieve 5% or greater weight loss “should focus on increasing initial uptake and sustaining engagement in WMT.”

There were some limitations in the study. For example, the researchers used EHR data from a single academic center, and the study occurred before the FDA’s approval of semaglutide 2.4 mg (Wegovy, Novo Nordisk) for weight management, “and thus our findings may understate current use and effectiveness of [antiobesity medications].”

Henderson and colleagues concluded that health systems and insurers “should consider novel strategies to enhance preference-sensitive use of WMT to optimize achievement of 5% or greater weight loss among individuals and populations with obesity.”

“Additionally, given their potential weight-loss effectiveness and lower cost, future work should explore strategies to enhance patient-centered use of all WMT,” they wrote.