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Real World Use of Anti-Obesity Medications and Weight Change in Veterans

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Abstract

Background

Anti-obesity medications (AOMs) can be initiated in conjunction with participation in the VA national behavioral weight management program, MOVE!, to help achieve clinically meaningful weight loss.

Objective

To compare weight change between Veterans who used AOM + MOVE! versus MOVE! alone and examine AOM use, duration, and characteristics associated with longer duration of use.

Design

Retrospective cohort study using VA electronic health records.

Participants

Veterans with overweight or obesity who participated in MOVE! from 2008–2017.

Main Measures

Weight change from baseline was estimated using marginal structural models up to 24 months after MOVE! initiation. The probability of longer duration of AOM use (≥ 180 days) was estimated via a generalized linear mixed model.

Results

Among MOVE! participants, 8,517 (1.6%) used an AOM within 24 months after MOVE! initiation with a median of 90 days of cumulative supply. AOM + MOVE! users achieved greater weight loss than MOVE! alone users at 6 (3.2% vs. 1.6%, p < 0.001), 12 (3.4% vs. 1.4%, p < 0.001), and 24 months (2.7% vs. 1.5%, p < 0.001), and had a greater probability of achieving ≥ 5% weight loss at 6 (38.8% vs. 26.0%, p < 0.001), 12 (43.1% vs. 28.4%, p < 0.001), and 24 months (40.4% vs. 33.3%, p < 0.001). Veterans were more likely to have ≥ 180 days of supply if they were older, exempt from medication copays, used other medications with significant weight-gain, significant weight-loss, or modest weight-loss side effects, or resided in the West North Central or Pacific regions. Veterans were less likely to have ≥ 180 days of AOM supply if they had diabetes or initiated MOVE! later in the study period.

Conclusions

AOM use following MOVE! initiation was uncommon, and exposure was time-limited. AOM + MOVE! was associated with a higher probability of achieving clinically significant weight loss than MOVE! alone.

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Acknowledgements

We thank Natalie Bontrager for editorial support (e.g., creating the patient flow chart). Support for VA/CMS data was provided by the Department of Veterans Affairs, VA Health Services Research and Development Service, VA Information Resource Center (Project Numbers SDR 02-237 and 98-004). The weight-change analysis was conducted in “AWS VA Enterprise Cloud Prospect” enclave and we would like to thank Dr. Siamack Ayandeh for the creation of the analytics study mart environment and the VHA Office of the Research and Development for funding of the Cloud Credits.

Funding

This research was funded by the IIR 18–019 (MLM, EW), AH was supported by a Career Development Award (IK2 HX003359), DB was supported by a Career Development Award (IK2 HX003085) and MLM was supported by a Senior Research Career Scientist award (RCS 10–391), all from VA HSR&D. Additional support by the Center of Innovation to Accelerate Discovery and Practice Transformation (CIN 13–410) at the Durham VA Health Care System is acknowledged.

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Authors and Affiliations

  1. Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, USA

    Anna Hung PharmD, PhD, MS, Paul A. Dennis PhD, MSA, Karen M. Stechuchak MS, Dan V. Blalock PhD, Valerie A. Smith DrPH & Matthew L. Maciejewski PhD

  2. Department of Population Health Sciences, Duke University, Durham, NC, USA

    Anna Hung PharmD, PhD, MS, Paul A. Dennis PhD, MSA, Valerie A. Smith DrPH & Matthew L. Maciejewski PhD

  3. Duke-Margolis Center for Health Policy, Durham, NC, USA

    Anna Hung PharmD, PhD, MS & Matthew L. Maciejewski PhD

  4. Seattle-Denver COIN, Seattle, WA, USA

    Edwin S. Wong PhD & Katherine Hoerster PhD

  5. Department of Health Systems and Population Health, University of Washington School of Medicine, Seattle, WA, USA

    Edwin S. Wong PhD & Katherine Hoerster PhD

  6. Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA

    Dan V. Blalock PhD & Susan D. Raffa PhD

  7. Division of General Internal Medicine, Department of Medicine, Duke University, Durham, NC, USA

    Valerie A. Smith DrPH & Matthew L. Maciejewski PhD

  8. Center for Healthcare Organization and Implementation Research, VA Bedford Medical Center, Bedford, MA, USA

    Varsha G. Vimalananda MD, MPH

  9. Department of Medicine, Boston University School of Medicine, Boston, MA, USA

    Varsha G. Vimalananda MD, MPH

  10. National Center for Health Promotion and Disease Prevention, Veterans Health Administration, Durham, NC, USA

    Susan D. Raffa PhD

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  1. Anna Hung PharmD, PhD, MS
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Corresponding author

Correspondence to Anna Hung PharmD, PhD, MS.

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Conflict of Interest:

MLM reports research grants from NIH and VA HSR&D and ownership of Amgen stock due to his spouse’s employment. VAS reports research grants from NIH and VA HSR&D. AH reports research grants from NIH, VA HSR&D, AstraZeneca, and Abbott. All other authors declare no conflicts of interest.

Role of the Sponsor

The Health Services Research and Development Service, Department of Veterans Affairs had no role in the design, conduct, collection, management, analysis, or interpretation of the data; or in the preparation, review, or approval of the manuscript. The opinions expressed are those of the authors and not necessarily those of the Department of Veterans Affairs, the United States Government, Duke University, or the University of Washington.

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Hung, A., Wong, E.S., Dennis, P.A. et al. Real World Use of Anti-Obesity Medications and Weight Change in Veterans. J GEN INTERN MED 39, 519–528 (2024). https://doi.org/10.1007/s11606-023-08501-z

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