WEIGHT LOSS EFFECTIVENESS OF GLUCAGON-LIKE PEPTIDE-1 RECEPTOR AGONISTS (GLP-1RAS) WHEN USED WITH AND WITHOUT LIFESTYLE MODIFICATIONS: A RETROSPECTIVE REAL-WORLD STUDY
Author(s)
Iris Chin, PhD, Richie Siburian, MA, Raunaq Malhotra, PhD, Gaurav Kaushik, PhD.
Veradigm, Chicago, IL, USA.
Veradigm, Chicago, IL, USA.
OBJECTIVES: To assess the role of lifestyle factors (diet and exercise) on the effectiveness of GLP-1RAs in weight loss using real-world data (RWD).
METHODS: Patients who initiated a GLP-1RA (semaglutide, tirzepatide, liraglutide, dulaglutide, exenatide, or lixisenatide) between 01/01/2019-07/17/2025 (earliest start or written date=index) without history of bariatric surgery were identified using the Veradigm Network EHR. Ninety-day windows were created from index, with pre-initiation as baseline. Patients' weight and engagement in no diet/exercise, exercise-only, diet-only, or diet and exercise were captured at each window up to one-year post-initiation. Patients were required to have weight and lifestyle factors captured at baseline and at least one post-index window. Weight change over time was evaluated via a linear mixed effects model, with patient-level random intercepts and time*lifestyle interaction, along with other fixed-effects such as demographics. Lifestyle factors were extracted from clinical notes using an AI curation pipeline that was validated by clinicians; all other features were captured from structured fields in the EHR.
RESULTS: Of the 2745 GLP-1RA patients, 64% were female, with a mean age of 52 years, baseline weight of 221 pounds, and majority on semaglutide (58%). Pairwise comparisons of the model's lifestyle group coefficient estimates revealed no significant differences in baseline weight across groups, p-values>.05. Lifestyle groups differed significantly from the reference group (no exercise/diet) in weight loss over time, p-values<.01. No exercise/diet patients lost on average 1.85 pounds per 90-day window, with the other groups losing additional weight per window on top of this: an additional 2.28 for diet and exercise, 1.25 for diet-only, and 0.84 for exercise-only.
CONCLUSIONS: GLP-1RA used alongside lifestyle modifications was associated with greater weight loss than GLP-1RA alone. Incorporating both diet and exercise led to the most weight loss, followed by diet-only and exercise-only lifestyle modifications, highlighting the key role of diet in GLP-1RAs’ effectiveness.
METHODS: Patients who initiated a GLP-1RA (semaglutide, tirzepatide, liraglutide, dulaglutide, exenatide, or lixisenatide) between 01/01/2019-07/17/2025 (earliest start or written date=index) without history of bariatric surgery were identified using the Veradigm Network EHR. Ninety-day windows were created from index, with pre-initiation as baseline. Patients' weight and engagement in no diet/exercise, exercise-only, diet-only, or diet and exercise were captured at each window up to one-year post-initiation. Patients were required to have weight and lifestyle factors captured at baseline and at least one post-index window. Weight change over time was evaluated via a linear mixed effects model, with patient-level random intercepts and time*lifestyle interaction, along with other fixed-effects such as demographics. Lifestyle factors were extracted from clinical notes using an AI curation pipeline that was validated by clinicians; all other features were captured from structured fields in the EHR.
RESULTS: Of the 2745 GLP-1RA patients, 64% were female, with a mean age of 52 years, baseline weight of 221 pounds, and majority on semaglutide (58%). Pairwise comparisons of the model's lifestyle group coefficient estimates revealed no significant differences in baseline weight across groups, p-values>.05. Lifestyle groups differed significantly from the reference group (no exercise/diet) in weight loss over time, p-values<.01. No exercise/diet patients lost on average 1.85 pounds per 90-day window, with the other groups losing additional weight per window on top of this: an additional 2.28 for diet and exercise, 1.25 for diet-only, and 0.84 for exercise-only.
CONCLUSIONS: GLP-1RA used alongside lifestyle modifications was associated with greater weight loss than GLP-1RA alone. Incorporating both diet and exercise led to the most weight loss, followed by diet-only and exercise-only lifestyle modifications, highlighting the key role of diet in GLP-1RAs’ effectiveness.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
CO146
Topic
Clinical Outcomes
Topic Subcategory
Comparative Effectiveness or Efficacy
Disease
Diabetes/Endocrine/Metabolic Disorders (including obesity), No Additional Disease & Conditions/Specialized Treatment Areas