Obese/overweight patients incur 10 percent long-term weight loss with lifestyle management, medication

Individuals who are overweight or obese can achieve an approximately 10 percent weight loss over 3–5 years with the use of anti-obesity medications in addition to lifestyle management, according to a retrospective study presented at ENDO 2022.

“A 10 percent weight loss is clinically significant because it is associated with improvements in cardiovascular risk factors like diabetes, hypertension, high cholesterol, and obstructive sleep apnoea, as well as improvements in mobility and overall quality of life,” said lead researcher Dr Michael Weintraub from Weill Cornell Medicine in New York, New York, US.

This observational study involved 428 adults aged 18–75 years (mean age 50.9 years, 73 percent female) who received treatment for overweight/obesity at a tertiary academic weight management centre. All patients received counselling from an obesity specialist on following a low-glycaemic diet and exercise plan, as well as potential additional counselling from a dietitian. They were also given access to anti-obesity medications, both FDA-approved and off-label.

Median BMI at baseline was 34.3 kg/m². Nineteen percent of patients were overweight and 35, 25, and 20 percent were categorized as class 1, 2, and 3 obesity, respectively. Sixteen percent of patients had diabetes and 36 percent had prediabetes.

Patients who were pregnant, had undergone bariatric surgery, or had a medical condition that predisposed them to weight loss during the study were excluded.

The patients were followed up for a mean 4.4 years. During this time, the average weight loss between the first and final visits was -10.9 kg or -10.6 percent. Median BMI at the final visit was 27.4 kg/m². [ENDO 2022, abstract OR10]

Maximum weight loss was a median 14.7 percent and the median nadir BMI was 25.6 kg/m². The patients took a median 1.9 years to reach their nadir weight. Weight regain following the nadir weight was 6.3 percent over the follow-up period. 

Total weight loss of >20 percent was achieved by 16.8 percent of patients, while 70.8, 48.1, and 30.1 percent achieved weight loss of >5, >10, and >15 percent, respectively.

Patients were on a mean 4.2 anti-obesity medications during the study. At the final visit, the patients were on a mean 2.5 anti-obesity medications, the most common being metformin (76.2 percent), phentermine (31.1 percent), topiramate (30.8 percent), bupropion (29.9 percent), and semaglutide (24.5 percent).

“Data on the effectiveness of anti-obesity medications for long-term weight loss maintenance in the real world has been limited to 1 to 2 years,” noted Weintraub.

“Our study is unique because we analysed weight loss maintenance over 3–5 years in more than 400 adults with overweight and obesity who were taking weight-loss medications,” he added.

“Anti-obesity medications are an underutilized treatment option for obesity and can prevent obesity-related diseases including diabetes and cardiovascular disease. This research supports the utility of anti-obesity medications in achieving long-term weight loss maintenance,” Weintraub concluded.