Abstract
Background: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have revolutionized weight management. Obesogenic medications can lead to weight gain of 0.3-2.6 kg, complicating the comanagement of obesity. The impact of potential weight loss in patients prescribed GLP-1RAs and concomitant obesogenic medications has yet to be explored. Objective: Investigators compared weight loss experienced in veterans prescribed injectable semaglutide and obesogenic medications with those not prescribed obesogenic medications. Methods: Investigators performed a single-center, retrospective chart review. The primary outcome was the difference in percentage weight change from baseline to 6 months. The secondary outcomes included percentage change in body mass index (BMI), weight loss in pounds (lbs), change in BMI, number of obesogenic medications discontinued during the study period, and stratification of weight loss by number of obesogenic medication exposures, type of obesogenic medication exposure, and maximum dose of injectable semaglutide achieved. Results: Patients in the nonobesogenic cohort experienced a median (interquartile range [IQR]) weight loss of 8.1% (−6%) compared with 6.9% (−8.8%) in the obesogenic cohort, with a median weight loss of 21.6 lbs (−15.8) versus 17.4 lbs (−23.8), respectively. The median change in BMI was −8.1 (−6) in the nonobesogenic cohort compared with −6.9 (−8.9) in the obesogenic cohort. Patients prescribed up to 5 obesogenic medications experienced weight loss up to 12.5% (−3.6%). Patients prescribed 6 obesogenic medications experienced a 14.5% weight gain (11.4%). The least weight gain was seen in patients prescribed antidiabetics (0.87%, IQR −5.6%), with the highest loss in those prescribed contraceptives (23.6%, IQR 0%). Patients titrated to 1.7 mg experienced the most weight loss of 9.8% (−19.9%). A range of 0-4 medications were discontinued. Conclusions: Using obesogenic medications in patients prescribed injectable semaglutide for obesity led to numerically lower weight loss than patients not prescribed obesogenic medications. However, patients prescribed obesogenic medications were able to achieve a large total body weight loss.