Weight Management Medications Research Articles

Metabolic dysregulation in obese women and the carcinogenesis of gynecological tumors: A review.

Obesity is a significant health issue associated with increased cancer risks, including gynecological malignancies. The worldwide rise in obesity rates is significantly impacting both cancer development and treatment outcomes. Adipose tissue plays a crucial role in metabolism, secreting various substances that can influence cancer formation. In obese individuals, dysfunctional adipose tissue can contribute to cancer development through inflammation, insulin resistance, hormonal changes, and abnormal cholesterol metabolism. Studies have shown a strong correlation between obesity and gynecological cancers, particularly endometrial and breast cancers. Obesity not only increases the risk of developing these cancers but is also associated with poorer outcomes. Additionally, obesity affects the perioperative management of gynecological cancers, requiring specialized care due to increased complications and resistance to therapy. Treatment strategies for managing metabolic dysregulation in patients with gynecological cancers include weight management, statin therapy, and insulin-sensitizing medications. Emerging studies suggest that interventions like intermittent fasting and caloric restriction may enhance the effectiveness of cancer treatments. Furthermore, targeting cholesterol metabolism, such as with statins or proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, shows potential in cancer therapy. In conclusion, addressing metabolic issues, particularly obesity, is crucial in preventing and treating gynecological malignancies. Personalized approaches focusing on weight management and metabolic reprogramming may improve outcomes in these patients.

Hospitalist Recognition and Treatment of Obesity in Inpatients: A Quality Improvement Cohort Study

Background: Obesity is primarily managed in the outpatient setting, however its impact on the frequency and course of hospitalizations is well-established. Considering the rising prevalence of obesity and the broad implications on population health when untreated, hospitalizations may represent an untapped opportunity to address obesity management. Methods: We performed a retrospective cohort study comparing the frequency of inpatient obesity documentation to initiation of obesity-targeted therapy, including weight management clinic referral and weight management medication prescription on discharge from hospitalization by hospitalists for patients with class 2 and 3 obesity. We also queried the frequency of weight management clinic referrals and weight management medication prescriptions prior to hospitalization for these cohorts. Results: The cohorts included 1531 patients with class 2 (49.2%) or class 3 (50.8%) obesity. During hospitalization, obesity was frequently documented as a medical problem in patients with both class 2 (48.4%) and class 3 (75%) obesity. Patients with class 3 obesity were more likely to be referred on discharge to a weight management clinic and initiated on weight management medications, however the overall absolute number of referrals and prescriptions were low. Conclusions: We observed that hospitalists documented the presence of obesity in over 60% of patients, yet rarely implemented targeted treatment on discharge. Our results suggest a gap exists between awareness of obesity and subsequent intervention. This highlights an opportunity to generate an inpatient workflow to bridge a gap in care for patients with obesity.

Knowledge and Attitude of the General Population in Saudi Arabia Toward Weight Management Medications (WMMs): A Cross-Sectional Study.

Over the past decades, the global prevalence of obesity has tripled, with the Kingdom of Saudi Arabia experiencing a notably higher rate of increase. While lifestyle modifications remain the first line of treatment, pharmacological interventions are often employed when dietary and exercise interventions prove insufficient. However, safety concerns, misuse, and limited knowledge about weight management medications (WMMs) pose serious challenges. The objectives of this study were to determine the level of knowledge and examine attitudes towards WMMs among the general population, and to explore the factors associated with these knowledge levels and attitude patterns. A cross-sectional study was conducted among adults from the general population in Saudi Arabia from January 2023 to May 2023. Participants completed a validated, self-administered electronic questionnaire in Arabic language. The questionnaire captured sociodemographic, lifestyle and health data, knowledge about WMMs, and attitudes toward them. The outcome measures included knowledge and attitudes scores. Factors associated with knowledge and attitudes were analyzed using chi-square tests. Statistical significance was determined at a p-value of <0.05. Around 716 respondents were included in the final analysis. Most of the participants acknowledged diet 565 (78.9%) and exercise 621 (86.7%) as effective strategies to lose weight. Only 222 (31.0%) participants recognized pharmaceutical medications as a weight management strategy. Knowledge about specific weight loss medications varied, with the highest recognition for semaglutide (Ozempic®, Novo Nordisk, Bagsværd, Denmark) 236 (33.0%) and liraglutide (Saxenda®, Novo Nordisk, Bagsværd, Denmark) 228 (31.8%), while the other WMMs were not commonly known between participants. Regarding attitudes, the majority disagreed with statements that WMMs are more effective than diet/exercise 413 (57.7%), are safe 405 (56.6%), and are more convenient to use 408 (57.0%). Notably, about three-quarters [534 (74.6%)] of participants agreed that these medications require specialist's counseling. No correlation was observed between knowledge score and attitude score (Pearson's correlation coefficient r=0.03; p=0.330). Respondents' knowledge about WMMs was significantly influenced by age, monthly income, educational level, psychiatric history, and previous use of WMMs (p<0.05). Adequate knowledge was more prevalent among participants aged 26-35, earning more than 20K SAR monthly, postgraduates, those with a psychiatric history, and past users of WMMs. Attitudes toward WMMs, however, showed no significant association with sociodemographic or health-related factors (p>0.05). However, prior use of WMMs significantly correlated with attitudes (p=0.007), with past users demonstrating more favorable attitudes. This study reveals a limited knowledge and cautious attitude regarding WMMs in the Saudi population, despite the high prevalence of obesity. With prior use of WMMs correlating with better knowledge and more favorable attitudes, these findings emphasize the need for targeted interventions to enhance public awareness and safe usage of these medications.

1692-P: Designing and Testing a Novel Weight Navigation Program to Improve Obesity Treatment in Primary Care Settings

Background: We developed and tested a novel Weight Navigation Program (WNP). The WNP aims to (1) integrate American Board of Obesity Medicine Diplomates into primary care teams, (2) deliver preference-sensitive weight management treatment, and (3) optimize patients’ achievement of ≥5% weight loss through remote weight monitoring with proactive outreach to support patients with &amp;lt;5% weight loss. Methods: This is a quality improvement program conducted at an academic primary care site from October 2020 to September 2021. WNP inclusion criteria are BMI ≥30 and ≥1 weight-related condition. Primary outcomes were measures of feasibility, including rates of referral to and engagement in the WNP. Secondary outcomes were mean weight loss and percentage of patients achieving ≥5% weight loss. We compared rates of referral to weight management treatment programs (i.e., nutrition counseling, meal replacement (MR), bariatric surgery) and prescribing of weight management medications (WMMs) among WNP-eligible patients at the pilot site and at a nearby clinic (control). Rates are also reported for patients with a completed WNP visit. Results: Of 1,533 eligible patients, 238 (16%) were referred to the WNP and 135 (9%) completed a WNP visit. Mean percent weight change at 12-months for WNP patients was 5% and 39% achieved ≥5% weight loss. WNP-eligible patients at the WNP site (n=1,533) were referred to WMTs and prescribed WMMs at similar rates to WNP-eligible patients at the control site (n=2,913) (nutrition counseling 4.8% v. 6.8%, MR 1.0% v. 0.6%, WMM 2.0% v. 3.2%, bariatric surgery 1.2% vs. 1.8%). Patients with a completed WNP visit (n=135) received WMTs at substantially higher rates than the pilot and control sites (nutrition counseling 26.7%, MR 13.3%, WMM 11.9%, bariatric surgery 16.3%). Discussion: A WNP is feasible and may support achievement of ≥5% weight loss. Additional work is needed to compare the efficacy of WNP vs usual care for weight loss. Disclosure D.H.Griauzde: None. A.T.Kraftson: None. C.D.Turner: None. J.Henderson: None. A.Othman: None. L.Oshman: Stock/Shareholder; Abbott, AbbVie Inc., Merck &amp; Co., Inc., Procter &amp; Gamble, Johnson &amp; Johnson, Eli Lilly and Company. J.Gabison: None. E.Walford: None. P.K.Arizaca-dileo: None. D.I.Beckius: None. Funding University of Michigan Elizabeth Weiser Caswell Diabetes Institute; Michigan Center for Diabetes and Translational Research (P30DK092926-09 to D.H.G.); National Institute of Diabetes and Digestive and Kidney Diseases (K23DK123416-01A1 to D.H.G.)

SAFETY OF ANTI-OBESITY AGENTS IN ADULTS NARRATIVE REVIEW

Background: Weight management medications are appropriate treatment options for individuals who are overweight or obese and have been unable to achieve weight loss with lifestyle intervention alone. In this narrative review, we aimed to review the adverse effects and safety profile of anti-obesity agents in overweight and obese patients. Methods: PubMed database was were systematically searched for relevant studies published between January 2012 and July 2022 of randomized controlled trials phase II or III of anti-obesity agents, for adult 18 years old with overweight or obesity without diabetes mellitus or secondary causes of obesity.Studies that met eligibility criteria were extracted and reviewed. 48 studies were screened for eligibility, among them, 18 studies fulfill inclusion criteria and involved in the narrative review.

Protocol and short-term results for a feasibility randomized controlled trial of a video intervention for Veterans with obesity: The TOTAL (Teaching Obesity Treatment Options to Adult Learners) pilot study

IntroductionAll three evidence-based treatment options for adults with severe obesity – behavioral weight management, weight management medications (WMM), and bariatric surgery – are underutilized in the Veterans Health Administration (VHA) system. Our objective in this study was to develop and pilot-test the TOTAL (Teaching Obesity Treatment Options to Adult Learners) intervention, which seeks to increase Veteran participation in obesity treatment. MethodsIn this single-site, parallel, pilot RCT, Veterans with severe obesity with an upcoming behavioral weight management visit were sent a recruitment letter after meeting inclusion/exclusion criteria via electronic health record screening. Eligible Veterans were randomized to TOTAL or usual care. TOTAL consisted of an 18-min video highlighting obesity health risks and treatment outcomes, eligibility criteria, and pros/cons of all three evidence-based obesity treatments. The primary outcomes were trial design feasibility (recruitment and retention rates) and acceptability to Veterans, which was assessed via semi-structured interviews with participants one week after randomization to TOTAL. Secondary outcomes included attitudes and self-efficacy to initiate treatment one week post-randomization and BMI change six months post-randomization (assessed via Cohen's d). ResultsForty-two Veterans were randomized (recruitment rate = 47.2%), and 40/42 completed one-week assessments (retention rate = 95.2%). The mean participant age was 59.2 ± 11.9 years. Female and non-White participants comprised 14.3% and 11.9% of the cohort, respectively. Semi-structured interviews with all 20 participants who received TOTAL suggested that the delivery logistics and content of TOTAL were acceptable to Veterans. Attitudes toward behavioral weight management and bariatric surgery and weight loss improved in TOTAL vs. usual care patients (Cohen's d ranging from 0.3 to 0.6). ConclusionsTOTAL was feasible to implement, acceptable to Veterans, and has the potential to increase obesity treatment participation in VHA. An adequately powered RCT is warranted to assess its impact on population-level weight loss. Trial registrationClinicalTrials.gov NCT03856320.

Evaluation of Pharmacologic Interventions for Weight Management in a Veteran Population.

Veterans are disproportionately impacted by weight-related morbidity: 40% of veterans are categorized as obese and an additional 38.5% are overweight. Medications are recommended as an adjunct to lifestyle and dietary changes. Guidelines recommend 7 weight management medications, including orlistat, liraglutide, phentermine, phentermine/topiramate, lorcaserin, and naltrexone/bupropion. A single-center, retrospective chart review was conducted for patients who started weight management medications at Veteran Health Indiana in Indianapolis. The primary outcomes included total weight loss and weight loss as a percentage of baseline weight at 3, 6, 12, and > 12 months of therapy. Secondary outcomes included weight loss of 5% from baseline, rate of successful weight maintenance after initial weight loss of 5% from baseline, adverse drug reaction monitoring, and use of weight management medications across clinics at this site. The absolute weight difference over 12 months of weight management medication therapy was 15.8 kg. At each time point, weight loss was found to be statistically significant when compared with baseline (P < .001). Average weight change was greatest with orlistat (-25.9 kg) and naltrexone/bupropion was associated with a gain of 2.1 kg over the duration of the study. A majority of the patients analyzed lost the guideline-recommended 5 to 10% from baseline while taking weight management medication. Weight management medications in a veteran population produced initial weight loss consistent with previous studies. However, there is room for improvement in follow-up strategies to promote greater weight maintenance after initial weight loss. Considering the high health care costs, personal burden, and potential long-term complications associated with obesity, efforts to promote continued development of programs that support weight management and maintenance are imperative.

Safety and Tolerability of Concomitant Administration of Multiple-Dose AM833 With Semaglutide 2.4 MG for Weight Management

Background: Combining weight management medications with different modes of action may provide more effective treatment options for people with obesity. Subcutaneous (sc) AM833, a long-acting amylin analog, and sc semaglutide 2.4 mg, a glucagon-like peptide-1 receptor agonist, are both under clinical development for weight management. Methods: This was a randomized, double-blind, placebo-controlled, phase 1 trial to investigate the safety, tolerability, pharmacokinetics (PK), and pharmacodynamics of concomitant administration of six ascending doses of weekly AM833 (0.16, 0.3, 0.6, 1.2, 2.4, or 4.5 mg) + semaglutide vs placebo + semaglutide in subjects with overweight or obesity. The 20-week trial included a 16-week escalation period followed by a 4-week treatment period at target dose and a 5-week follow-up. Eligible subjects were male or female of non-childbearing potential, aged 18–55 years, with BMI 27−39.9 kg/m2. The primary endpoint was number of adverse events (AE) from baseline to follow-up. Secondary endpoints included PK parameters (area under the curve [AUC] 0–168 h [AUC0-168], maximum concentration [Cmax], half-life [t1/2] and time to Cmax [tmax]). Changes in body weight (exploratory endpoint) were analyzed separately for AM833 0.16−2.4 mg + semaglutide (vs pooled placebo) and AM833 4.5 mg + semaglutide (vs matched placebo) due to a different semaglutide dose escalation regimen used in this treatment arm. Results: Of 96 subjects randomized, 95 were exposed to treatment (59% male; mean age 40.6 years, body weight 95.7 kg, BMI 32.1 kg/m2) and 80 (83%) completed the trial. The number of AEs ranged from 37–89 with AM833 (0.16–4.5 mg) + semaglutide and 132 with pooled placebo + semaglutide. Most AEs were mild or moderate and the proportion of subjects with ≥1 AE was similar across treatment arms. About one-third of all AEs were gastrointestinal (GI) disorders (n=207 of 566), primarily nausea, dyspepsia, and vomiting. A greater proportion of subjects reported GI AEs with AM833 1.2–4.5 mg + semaglutide vs placebo + semaglutide. The second most common AEs were injection site reactions (n=72), all mild and not dependent on AM833 dose. Exposure to AM833 was proportional to dose for both AUC0-168 and Cmax, and did not affect semaglutide exposure and elimination. AM833 0.16−4.5 mg t1/2 ranged from 159–195 h and median tmax ranged from 24–72 h. At week 20, body weight changes from baseline with AM833 1.2 and 2.4 mg + semaglutide were greater vs pooled placebo + semaglutide (−15.7% and −17.1% vs −9.8%, respectively; p<0.001) and with AM833 4.5 mg + semaglutide vs matched placebo + semaglutide (−15.4% vs −8.0%; p<0.01).Conclusion: Treatment with AM833 at all tested doses + semaglutide was generally well tolerated with an acceptable safety profile. PK data support once-weekly dosing. The combination of AM833 1.2, 2.4, or 4.5 mg + semaglutide led to greater weight loss compared with placebo + semaglutide.

44613 Plan for a Retrospective Evaluation of a Multi-Modal Weight-centric Prediabetes Intervention

ABSTRACT IMPACT: By demonstrating the feasibility of a multimodal, interdisciplinary intervention for prediabetes, the current project aims to provide a template for the prevention of diabetes and associate comorbid conditions. OBJECTIVES/GOALS: To determine if a multi-modal, interdisciplinary intervention delivered to a group of prediabetic patients will result in reduced rates of diabetes progression. This project is a retrospective evaluation that will exam the feasibility and possibly efficacy of this intervention. METHODS/STUDY POPULATION: We will enroll 50 participants for the clinic, aged 21-60 inclusive. Patients will have a Body Mass Index &gt;27kg/m2 with a diagnosis of prediabetes. Patients must be non-pregnant, using approved contraception, and agree to not become pregnant for 1 year after enrollment. After enrollment, the initial treatment period is for 1 year and includes a 12 week low calorie diet plan, a 6-month intensive behavioral and lifestyle modification plan followed by a 6 month behavior reinforcement extension. Weight management medications may be used if appropriate for the patient from a clinical perspective during the 6-month intensive behavioral/lifestyle modification. RESULTS/ANTICIPATED RESULTS: It is anticipated that there will be decreased weight with a mean weight loss goal of approximately &gt;10%. Furthermore, it is expect that there will be improvement of other markers of metabolic disease. These include improvement of lipid values (LDL-C, HDL-C, Triglycerides, Total Cholesterol) as well as blood pressure with expected blood pressures of below 130/80 in greater than 50% of participants. Finally, It is expected that 50% or greater participants will have improvement of glycemic control. It is anticipated that greater than 50% of participants will have improvement of glycemic control and achieve normoglycemia. These values will be determined based upon fasting glucose or A1c. DISCUSSION/SIGNIFICANCE OF FINDINGS: The significance of this intervention is enormous. By demonstrating feasibility in this trial, we can work toward both assessing efficacy and possibly dissemination of this model program. If these interventions provide durable changes at scale, this could help slow the epidemic of obesity and obesity related comorbid conditions.

Results of the ACTION-IO survey in Chilean patients with obesity and health care providers.

Most of the Chilean population has overweight or obesity. The ACTION-IO survey identified the perceptions, attitudes, and barriers to effective obesity care in people with obesity (PwO) and healthcare professionals (HCPs). To report the results of the survey in Chile. An online survey was conducted in 11 countries. In Chile, eligible PwO were adults with a body mass index ≥ 30 kg/m2. Eligible HCPs were physicians involved in direct patient care. The survey was completed by 1,000 PwO and 200 HCPs in Chile. Seventy four percent of PwO and 95% of HCPs agreed that obesity was a chronic disease. Most PwO (79%) assumed responsibility for their own weight loss, while 47% of HCPs considered weight loss to be the sole responsibility of their patients. Both 82% of PwO and 97% of HCPs believed that lack of exercise was a key barrier to weight loss. Sixty six percent of PwO and 58% HCPs noted that the cost of weight management medications, programs, and services was another barrier. Compared with HCPs, more PwO felt that genetic factors prevented weight loss (26 and 44% respectively). Few HCPs (19%) thought that their patients were motivated to lose weight, while 55% of PwO reported being motivated. Most (70%) PwO had discussed their weight problem with their HCP in the past 5 years, and of those that had not, 89% want their HCP to start a discussion about weight. Chilean data reveal misconceptions among PwO and HCPs about obesity and highlights the need to improve education about its biologic background and clinical management.

Pharmacologic Weight Loss: An Underutilized Practice in the Fight Against Obesity

Obesity is considered one of the most contemporary threats to non-communicable disease such as cardiovascular disease, diabetes, musculoskeletal disorders and even some types of cancers. Its worldwide prevalence has nearly tripled between 1975 and 2016. In 2016, more than 1.9 billion adults aged 18 years and older were categorized as overweight, and of these over 650 million adults were obese. However, Weight management medications (WMM) are currently underutilized as an adjunct to behavioral and lifestyle interventions. By way of example, only 2% of eligible veterans received prescriptions for pharmacologic weight loss in the 2014-2015 fiscal years, and up to 1% of obese U.S. individuals filled a prescription for a WMM between 2009-2013. There are currently five FDA-approved medications for long-term weight loss medications. We analyzed 24 randomized clinical trials of the five drugs and interpreted findings. Of those 24, lorcaserin (Belviq®), naltrexone and bupropion (Contrave®), and phentermine and topiramate (Qsymia®) had four studies each, while liraglutide (Saxenda®), and orlistat (Xenical®) had six studies each. Underutilization of pharmacologic weight corrective therapies that have been statistically and clinically proven to be valuable tools in reducing obesity and its related risk factors. Studies of the five FDA-approved drugs have demonstrated clinically significant positive effects on weight loss with differing effects on both cardiovascular and glycemic markers/risk factors.

4125 Plan for a Retrospective Evaluation of a Multi-Modal Weight-centric Prediabetes Intervention.

OBJECTIVES/GOALS: To determine if a multi-modal, interdisciplinary intervention delivered to a group of prediabetic patients will result in reduced rates of diabetes progression. This project is a retrospective evaluation that will exam the feasibility and possibly efficacy of this intervention. METHODS/STUDY POPULATION: We will evaluate outcomes of 50 participants for the clinic, aged 21-60 inclusive. Patients will have a Body Mass Index &gt;25kg/m2 with a diagnosis of prediabetes. Patients must be non-pregnant, using approved contraception, and agree to not become pregnant for 1 year after enrollment. After enrollment, the initial treatment period is for 1 year and includes a 12 week low calorie diet plan, a 6-month intensive behavioral and lifestyle modification plan followed by a 6 month behavior reinforcement extension. Weight management medications may be used if appropriate for the patient from a clinical perspective during the 6-month intensive behavioral/lifestyle modification. RESULTS/ANTICIPATED RESULTS: It is anticipated that there will be decreased weight with a mean weight loss goal of approximately &gt;10%. Furthermore, it is expect that there will be improvement of other markers of metabolic disease. These include improvement of lipid values (LDL-C, HDL-C, Triglycerides, Total Cholesterol) as well as blood pressure with expected blood pressures of below 130/80 in greater than 50% of participants. Finally, It is expected that 50% or greater participants will have improvement of glycemic control. It is anticipated that greater than 50% of participants will have improvement of glycemic control and achieve normoglycemia. These values will be determined based upon fasting glucose or A1c. DISCUSSION/SIGNIFICANCE OF IMPACT: The significance of this intervention is enormous. By demonstrating feasibility in this trial, we can work toward both assessing efficacy and possibly dissemination of this model program. If these interventions provide durable changes at scale, this could help slow the epidemic of obesity and obesity related comorbid conditions.

Real-world persistence with liraglutide 3.0 mg for weight management and the SaxendaCare® patient support program.

SummaryObjectiveWeight management medications can significantly increase patients' chances of achieving a clinically meaningful weight loss if patients persist with treatment. This retrospective observational study of de‐identified medical records of 311 patients is the first real‐world study examining persistence with liraglutide 3.0 mg in Canada, and also investigates associations between the SaxendaCare® patient support program and persistence and weight loss.MethodsOverall persistence was assessed, as well as associations of enrollment in SaxendaCare®, persistence and weight loss.ResultsOverall mean (standard deviation) persistence with liraglutide 3.0 mg was 6.3 (4.1) months, and 67.5% (n = 210) and 53.7% (n = 167) of patients persisted for ≥4 and ≥ 6 months, respectively. Enrollment in SaxendaCare® was associated with significantly longer persistence with liraglutide 3.0 mg and greater weight loss. Patients enrolled in SaxendaCare® (n = 119) persisted for 7.9 (4.0) versus 5.2 (3.8) months for those not enrolled (n = 184) (p < 0.001), and had significantly greater percent weight loss after 6 months regardless of the duration of their persistence (−7.9% vs −5.5% from baseline, p < 0.01).ConclusionsThese findings suggest that, in clinical settings, persistence with liraglutide 3.0 mg can exceed 6 months, and that enrolling in SaxendaCare® may be associated with comparatively longer persistence and, regardless of persistence, greater weight loss.

Efficacy and Safety of Liraglutide 3.0 mg in Individuals With Overweight or Obesity and Type 2 Diabetes Treated With Basal Insulin: The SCALE Insulin Randomized Controlled Trial.

OBJECTIVEMost individuals with type 2 diabetes also have obesity, and treatment with some diabetes medications, including insulin, can cause further weight gain. No approved chronic weight management medications have been prospectively investigated in individuals with overweight or obesity and insulin-treated type 2 diabetes. The primary objective of this study was to assess the effect of liraglutide 3.0 mg versus placebo on weight loss in this population.RESEARCH DESIGN AND METHODSSatiety and Clinical Adiposity—Liraglutide Evidence (SCALE) Insulin was a 56-week, randomized, double-blind, placebo-controlled, multinational, multicenter trial in individuals with overweight or obesity and type 2 diabetes treated with basal insulin and ≤2 oral antidiabetic drugs.RESULTSIndividuals were randomized to liraglutide 3.0 mg (n = 198) or placebo (n = 198), combined with intensive behavioral therapy (IBT). At 56 weeks, mean weight change was −5.8% for liraglutide 3.0 mg versus −1.5% with placebo (estimated treatment difference −4.3% [95% CI −5.5; −3.2]; P < 0.0001). With liraglutide 3.0 mg, 51.8% of individuals achieved ≥5% weight loss versus 24.0% with placebo (odds ratio 3.41 [95% CI 2.19; 5.31]; P < 0.0001). Liraglutide 3.0 mg was associated with significantly greater reductions in mean HbA1c and mean daytime glucose values and less need for insulin versus placebo, despite a treat-to-glycemic-target protocol. More hypoglycemic events were observed with placebo than liraglutide 3.0 mg. No new safety or tolerability issues were observed.CONCLUSIONSIn individuals with overweight or obesity and insulin-treated type 2 diabetes, liraglutide 3.0 mg as an adjunct to IBT was superior to placebo regarding weight loss and improved glycemic control despite lower doses of basal insulin and without increases in hypoglycemic events.

Patient Characteristics Associated with Receipt of Prescription Weight-Management Medications Among Veterans Participating in MOVE!

Weight-management medications (WMM) are recommended for the treatment of obesity. This study examined characteristics associated with initial receipt of WMM among eligible veterans in the first year following enrollment in the Veterans Health Administration (VHA) MOVE! behavioral weight-management program. We conducted a retrospective cohort study of VHA patients with obesity or overweight and obesity-related comorbidities who enrolled in MOVE! from October 2013 to September 2016 (N = 153,939). Multivariable logistic regression models estimated predictors of having a filled prescription for WMM and for orlistat. A total of 1.1% of these veterans received WMM. The most common WMM included orlistat (70.4%), phentermine/topiramate (11.2%), and bupropion/naltrexone (9.7%). Female sex, higher BMI, obstructive sleep apnea, osteoarthritis, depression, lower back pain, and alcohol abuse were associated with greater odds of use of WMM, whereas age over 65 years, Hispanic ethnicity, and required co-payments were associated with lower odds. Among patients receiving WMM, older age, black race, female sex, higher BMI, cardiovascular disease, lower back pain, and congestive heart failure were associated with use of orlistat versus any other WMM. Of patients engaged in MOVE! in the VHA, 1.1% received WMM. WMM are underutilized among veterans. Additional research is needed to understand barriers to incorporating WMM into comprehensive obesity treatment plans.

OR01-2 Patient Characteristics Associated with Receipt of Prescription Weight Management Medications among Veterans in a Weight Management Program

Objective: Overweight and obesity affect over 4 million veterans receiving health care in the Veterans Administration (VA). In VA, WMM are available to any Veteran who is engaged in behavioral weight management and meets BMI criteria. In 2010, weight management medications (WMM) were found to be underused in VA, but since then new WMM have been approved and guidelines have recommended them for long-term obesity treatment. We examined the frequency of WMM use and patient characteristics associated with WMM use and with the selection of orlistat versus other WMM for veterans with overweight or obesity enrolled in the VA MOVE! behavioral weight management program. Methods: Retrospective cohort study of VA patients participating in MOVE! between October 2014 – October 2016 with body mass index (BMI)≥30kg/m2 or BMI>27kg/m2 with obesity-related comorbidities. Data from the electronic health record were accessed. Logistic regression models estimated predictors of filling a prescription for any WMM within VA and for orlistat versus other WMM. Results: Of the 153,892 eligible veterans enrolled in MOVE!, 1,888 (1.2%) received a WMM. The most common prescriptions were for orlistat (61.0%), bupropion/naltrexone (13.8%), and phentermine/topiramate (11.7%). The percent of patients receiving WMMs ranged from 0.5% among patients with overweight to 2.9% among patients with alcohol abuse. Factors associated with WMM were female sex (adjusted odds ratio (aOR) = 1.8, 95% CI: 1.6 – 2.0), higher BMI (class I obesity aOR=1.6, 95%CI: 1.3 – 2.0, class II obesity aOR=2.9, 95% CI: 2.3 – 3.6, class III obesity aOR=4.5, 95%CI: 3.6 – 5.6 compared to overweight), alcohol abuse (aOR=2.3, 95% CI: 1.8 – 2.9), substance abuse (aOR=1.6, 95% CI: 1.4 – 1.9), diabetes (aOR=1.2, 95% CI: 1.1-1.3), obstructive sleep apnea (aOR=1.3, 95% CI: 1.2 – 1.4), depression (aOR=1.2, 95% CI: 1.1 – 1.3), low back pain (aOR=1.2, 95% CI: 1.1 – 1.3). Factors associated with lower odds of WMM receipt included age over 65 years (aOR=0.7, 95% CI: 0.6 – 0.8) and required copayments (aOR=0.8, 95% CI: 0.7 – 0.8). Factors associated with receiving orlistat vs. other WMMs were increasing age (age ≥ 65 aOR=2.6, 95%CI: 1.6 – 4.1), Black/non-Hispanic race (aOR=1.5, 95% CI: 1.2 – 1.9), female sex (aOR=1.8, 95% CI: 1.4 – 2.3), hypertension (aOR=1.4, 95% CI: 1.1-1.7) and low back pain (aOR=1.6, 95% CI: 1.3-1.9). Factors associated with lower aOR for orlistat vs. other WMM were diabetes (aOR=0.7, 95% CI: 0.5-0.8), alcohol abuse (aOR=0.5, 95% CI: 0.3-0.9), and substance abuse (aOR=0.4, 95%CI: 0.3-0.6). Conclusion: There is a substantial opportunity to increase the use of WMM for weight management in eligible veterans engaged in MOVE!. Patient characteristics affect whether veterans receive WMM, and which WMM is used. Additional research is needed to understand provider and patient decision-making regarding WMM and address barriers to incorporating WMM into obesity treatment.

Dietary Modifications used for the Treatment of Type II Diabetes in Adults

Given the increasing prevalence of diabetes and obesity worldwide, lifestyle interventions must be made in order to improve health and decrease the risk for chronic disease. While nutritional intervention, physical exercise, weight management, and oral medications can all be used for glycemic control, no specific criteria for dietary modifications have been established in the treatment of type II diabetes mellitus (T2DM). Additionally, the limited generalizability of past studies has failed to assess these nutritional approaches from a social ecological standpoint. Consequently, by comparing the metabolic effects of a low carbohydrate, low fat, Mediterranean style, vegan, and vegetarian diet, it will be possible determine the long-term efficacy of such nutritional interventions. Moreover, these dietary treatments can be used to control and prevent the onset of T2DM through intrapersonal and interpersonal level modifications. However, further emphasis must be placed on T2DM management in order to prevent microvascular and macrovascular complications.

The effectiveness and safety of pharmaceuticals to manage excess weight post-bariatric surgery: a systematic literature review

Objective: To systematically review the literature on weight management pharmaceutical use in patients who have had bariatric surgery.Methods: Google Scholar, Pubmed, Cochrane, Embase, Web of Science, and Clinical Trials were searched from inception to December 31st, 2018 inclusive.Results: Thirteen studies met inclusion and reported decreases in weight with the use of weight management medications in post-bariatric surgical patients. Five studies examined weight loss outcomes by the type of bariatric surgery procedure, and four of these studies observed less weight loss in patients who had undergone gastric sleeve compared to those who had roux-en-y bypass (n = 3 papers) and adjustable gastric banding (n = 1 paper) with medication use. Four studies compared the effectiveness of medications for weight management and observed slightly greater weight loss with the use of topiramate and phentermine as a monotherapy compared to other weight loss medications. Using a sub-sample of participants, authors observed less weight loss on metformin but not phentermine or topiramate for younger adults. Another post-hoc analysis in the same sample observed greater weight loss for older adults with liraglutide 1.8 mg. Side effects were reported in seven studies and were overall consistent with those previously reported in non-surgical populations.Conclusion: Results of this systematic review suggest pharmacotherapy may be an effective tool as an adjunct to diet and physical activity to support weight loss in post-bariatric surgery patients. However, due to most studies lacking a control or placebo group, more rigorous research is required to determine the efficacy of this intervention.

Weight loss medications in Canada - a new frontier or a repeat of past mistakes?

Current methods for the treatment of excess weight can involve healthy behavior changes, pharmacotherapy, and surgical interventions. Many individuals are able to lose some degree of weight through behavioral changes; however, they are often unable to maintain their weight loss long-term. This is in part due to physiological processes that cannot be addressed through behavioral changes alone. Bariatric surgery, which is the most successful treatment for excess weight to date, does result in physiological changes that can help with weight loss and weight maintenance. However, many patients either do not qualify or elect to not have this procedure. Fortunately, research has recently identified changes in neurochemicals (i.e., orexigens and anorexigens) that occur during weight loss and contribute to weight regain. The neurochemicals and hormones may be able to be targeted by medications to achieve greater and more sustained weight loss. Two medications are approved in adjunction to lifestyle management for weight loss in Canada: orlistat and liraglutide. Both medications are able to target physiological processes to help patients lose weight and maintain a greater amount of weight loss than with just behavioral modifications alone. Two other weight management medications, which also target specific physiological processes to aid in weight loss and its maintenance, a bupropion/naltrexone combination and lorcaserin, are currently pending approval in Canada. Nonetheless, there remain significant barriers for health care professionals to prescribe medications for weight loss, such as a lack of training and knowledge in the area of obesity. Until this has been addressed, and we begin treating obesity as we do other diseases, we are unlikely to combat the increasing trend of obesity in Canada and worldwide.

Preconception care for women with type 2 diabetes mellitus: A mixed-methods study of provider knowledge and practice.

Preconception care may decrease adverse pregnancy outcomes associated with pre-existing diabetes mellitus. Aboriginal Australians are at high risk of type 2 diabetes mellitus (T2DM), with earlier onset. We explored practitioner views on preconception care delivery for women with T2DM in the Northern Territory, where 31% of births are to Aboriginal women. Mixed-methods study including cross-sectional survey of 156 health practitioners and 11 semi-structured interviews. Practitioners reported low attendance for preconception care however, 51% provided counselling on an opportunistic basis. Rural/remote practitioners were most likely to find counselling feasible. The majority (69%) utilised appropriate guidelines and addressed lifestyle modifications including smoking (81%), weight management (79%), and change medications appropriately such as ceasing ACE inhibitors (69%). Fewer (40%) prescribed the recommended dose of folate (5mg) or felt comfortable recommending delaying pregnancy to achieve optimal preconception glucose control (42%). Themes identified as barriers to care included the complexity of care setting and infrequent preconception consultations. There was a focus on motivation of women to make informed choices about conception, including birth spacing, timing and contraception. Preconception care enablers included cross-cultural communication, a multi-disciplinary care team and strong client-based relationships. Health practitioners are keen to provide preconception counselling and reported knowledge of evidence-based guidelines. Improvements are needed in recommending high dose folate and optimising glucose control. Cross-cultural communication and team-based care were reported as fundamental to successful preconception care in women with T2DM. Continued education and policy changes are required to support practitioners in opportunities to enhance pregnancy planning.