Evaluation of Pharmacologic Interventions for Weight Management in a Veteran Population

At the time of study, orlistat, liraglutide, phentermine/topiramate, lorcaserin, and naltrexone/bupropion were available at VHI for patients who met the criteria. All patients must have been enrolled in dietary and lifestyle management to be approved for these medications. The US Department of Veterans Affairs (VA) MOVE! weight management program, designed by the VA National Center for Health Promotion and Disease Promotion, is available at VA sites throughout the country. After MOVE! orientation, patients can participate in group or individual 12-week programs that include weigh ins, goal-setting strategies, meal planning, and habit modification support. If patients are unable to meet in person, phone and other telehealth opportunities are available.

Patients were included in the study if they received a prescription of any 1 of the 5 available medications during the enrollment period. Patients were excluded if they received a prescription from or were treated by a civilian health care provider, if they never used the medication, or if their weight loss was attributed to a cancer diagnosis. These criteria produced 86 patients of whom 96 unique weight loss prescriptions were generated. Data were collected for each instance of medication use so that some patients were included multiple times. In this case, data collection for the failed medication ended when failure was documented, and new data points began when new medication was prescribed; all data collected were per medication, not per patient. This method was used to account for medication failure and provide accurate weight loss results based on medication choice within this institution.

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 (ADR) monitoring, and use of weight management medications across clinics at VHI.

Demographic data included race, age, sex, baseline weight, BMI, and comorbid medical conditions. Comorbidities were collected based on the most recent primary care clinical note before initiating medication. Medication data collected included medications used to manage comorbidities. Data related to weight management medication included prescribing clinic, reason for medication discontinuation, or bariatric surgery intervention if applicable.

Efficacy outcome data included weight and BMI across therapy duration. Safety outcomes data included heart rate, BP, and ADRs that resulted in medication discontinuation as documented in the electronic health record (EHR).

We used descriptive statistics, including mean, standard deviation (SD), range, and percentage. For continuous data, Kruskal-Wallis tests were used because of nonparametric data distribution among the different medications with a prespecified α = 0.05. With the observed sample sizes and SDs in this study, post hoc poststudy power calculations showed that the study had 80% power at a 5% significance level to detect weight changes of 8.6 kg, 7.3 kg, and 12.4 kg at 3, 6, and 12 months, respectively, using nonparametric tests.

Results

A total of 86 patients were identified based on prescription fills, which produced 99 unique instances of medication use. Of the 99 identified, 3 met exclusion criteria and were not included in the final analysis. Among included veterans, 16 were female and 80 were male (Table 1). Most of those included identified as White race (86%), male (83%), and mean age 53 years. At baseline, mean weight was 130 kg and mean BMI 41.