A recent study published in the medical journal Obesity revealed that approximately 80% of individuals prescribed anti-obesity medications discontinue usage within one year. Other insights were both unsurprising and yet others, unexpected. Here’s the gist.
Three main findings
The key takeaways are these three main finds, illuminated by health and lifestyle journalist Laura Hensley reporting for Very Well Health, an online health and medical resource:
The majority of people who are prescribed anti-obesity medication discontinue the drugs at the one-year mark, according to new research
Wegovy (semaglutide), a newer medication, had the highest rate of patient adherence at one year compared to other, older drugs
Researchers suggest that the more effective an anti-obesity drug is, the longer a patient will likely stay on it
The weight-loss medication with the best adherence is…
The research, conducted by the Cleveland Clinic, indicated that at three months, 44% of patients filled their prescriptions, dropping to 33% at six months, and further decreasing to 19% at the 12-month mark. Notably, among the various anti-obesity drugs examined, semaglutide (marketed as Wegovy for weight management or Ozempic for type 2 diabetes) demonstrated the highest patient adherence, with 40% still taking the medication one year after the initial prescription. The study suggests a correlation between the effectiveness of anti-obesity medications and long-term patient adherence.
The study examined various anti-obesity medications, including Qsymia, Contrave, Xenical, Wegovy, and Saxenda, focusing on 1,911 adults with a BMI of 30 or higher who initiated FDA-approved weight management medication between 2015 and 2022. Researchers, using data from the Cleveland Clinic’s electronic health records, found that patients on newer, more effective drugs demonstrated better adherence compared to those on older, less effective medications.
Semaglutide (Wegovy) showed the highest adherence, having been FDA-approved for weight loss in 2021. A 68-week clinical trial revealed that Wegovy users lost an average of 12.4% of their initial body weight. In contrast, Naltrexone-bupropion (Contrave), approved in 2014, had lower adherence, with only about 10% of patients remaining on it at one year. Clinical data on phentermine-topiramate (Qsymia), approved in 2012, indicated varying percentages of patients achieving weight loss milestones over 56 weeks.
Reasons patients stop taking their anti-obesity meds
The Cleveland Clinic study did not directly look into the reasons behind patients discontinuing their anti-obesity medication, but it is suggested that some may have stopped within three months due to drug intolerance or dissatisfaction with early weight loss results. Possible side effects of these medications vary and may include nausea, vomiting, headache, dizziness, diarrhea, numbness or tingling, trouble sleeping, and dry mouth. (That is quite a list.)
Older anti-obesity medications, described as mild stimulants, might induce anxiety or elevate blood pressure. Hensley writes,
“Some of the older anti-obesity medications tend to be mild stimulants. They can create a little bit of anxiety or raise blood pressure,” Vijaya Surampudi, M.D., an assistant professor of medicine in the Division of Human Nutrition who works in the Center of Obesity and Metabolic Health at UCLA, told Verywell.
One of the oral anti-obesity medications does have an anti-addiction medicine in it called naltrexone, so you can’t be on any sort of narcotic painkiller [at the same time]. So if someone needs to have surgery, it’s very difficult to actually be on that anti-obesity medicine,” she said.
Another reason individuals may discontinue anti-obesity medication is the perception that weight management is temporary, as some believe they no longer need the medicine once they reach a comfortable weight. Despite expert opinions viewing obesity as a disease requiring chronic treatment, this mindset persists.
The study by Dr. Gasoyan and colleagues at the Cleveland Clinic did not specifically investigate why individuals stop medication, but they analyzed health insurance coverage’s impact on medication adherence. Reports suggest that some U.S. employers are considering restricting insurance coverage for anti-obesity pharmacotherapy due to perceived unsustainable costs and rapid weight gain after treatment discontinuation. Additionally, patients might stop taking weight management drugs simply because they can no longer afford them.
The study conducted by Dr. Gasoyan suggests that new data on the health benefits of newer anti-obesity medications could influence future coverage decisions by insurance providers. According to Hensley, Dr. Gasoyan said:
Our findings, along with future studies on determinants of non-persistence with anti-obesity medications, could offer opportunities for more nuanced insurance benefit design, incorporating evidence-based usage management tools, rather than limiting or eliminating anti-obesity medications coverage altogether.
The new promising weight-loss drug
The research did not include Zepbound (tirzepatide), a recently approved highly effective anti-obesity drug associated with significant weight loss. Gasoyan anticipates that the positive results seen in the study, where greater medium-term weight loss correlated with higher odds of persistence, could extend to newer drugs like tirzepatide, warranting further exploration in future research.
As parting advice, Dr. Surampudi emphasizes the importance of patient satisfaction with medications, stating that if a patient is unhappy with a specific drug, healthcare providers can work together to find alternative strategies for managing obesity.
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Source: “Which Anti-Obesity Medication Do Patients Stay On the Longest?,” VeryWellHealth.com, 1/11/24
Source: “Early- and later-stage persistence with antiobesity medications: A retrospective cohort study,” Obesity, 12/6/23
Source: “FDA Approves New Drug Treatment for Chronic Weight Management, First Since 2014,” FDA/gov, 6/4/21
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