BACKGROUND: Obesity has multiple drivers that affect treatment outcomes, making sustained weight loss challenging. Heterogeneity among patients with obesity is apparent in the varied level of patient engagement with treatment and weight loss response to interventions. Though many patients with obesity successfully lose weight in response to behavioral and lifestyle changes, half of these resume their original weight within 5 years.

OBJECTIVES: To understand the roles of patient profiles and behavior in discontinuation of anti-obesity medication (AOM) treatment.

METHODS: Study data (1/1/2019-6/30/2022) comprised integrated encounter, problem list and pharmacy tables from Heartland Weight Loss, a series of Midwest specialty weight loss clinics. Eligible individuals had >1 obesity encounter. Comorbidities were measured at intake. Treatment was tracked for 6 months post-intake. Treatment discontinuation was defined as > 30 days without medication. Chi-square and one-way ANOVA were used to test for statistical differences between continuation groups for categorical and continuous variables respectively.

RESULTS: Of the N=593 patients receiving obesity treatment who had 6 months or more follow-up data, most were female (91.6%), with mean age (SD) of 45.6 years (± 11.2 years). Three hundred sixty-two (61.0%) were prescribed at least 1 AOM while 44 (12.1%) were prescribed multiple AOMs: the most common were phentermine (37.7%), metformin (25.9%), naltrexone/bupropion or bupropion (19.9%), and semaglutide (18.2%). Of the 362 AOM initiators, 70 (19.3%) discontinued all AOMs within 6-months of intake. Those who discontinued treatment had fewer outpatient visits in the 6 months following intake compared to those who continued (9.1 v 10.2; p <0.05).

CONCLUSIONS: The majority of patients with obesity in this sample were prescribed an AOM. However, almost 1 in 5 patients discontinued their medication within 6 months of initiation. Greater number of outpatient visits was related to treatment continuation suggesting the potential role of engagement in successful treatment of obesity.