ABSTRACT
Background: Obesity is a chronic and relapsing disease, with a rising prevalence and a high economic burden. Obesity is a risk factor for COVID-19 infection severity and mortality. Anti-obesity medications (AOMs) are safe and effective for weight loss. However, weight loss outcomes with AOMs during the COVID-19 pandemic are yet to be described. We hypothesized that weight loss outcomes with AOMs during COVID-19 are inferior to those before this period. Methods: We performed a systematic review of electronic medical record of patients from the Mayo Clinic Health System. We included all patients who started a long-term FDA-approved AOM (phentermine-topiramate extended release [PHEN-TOP], naltrexone-bupropion sustained release [NBSR], and liraglutide 3.0 mg). We excluded patients with a history of bariatric surgery or endoscopic procedure, those taking ≥2 AOMs, ≥3 months of prescribed AOM, and/or pregnancy. Demographic and anthropometric data were ed from in person or virtual encounters. Analysis was divided by 1) those who started an AOM at least a year before COVID-19 restrictions were set in place in the USA (i.e. first quarter of 2019 period or earlier, defined as “PreCOVID-19”), and 2) those who started an AOM during or after the first quarter of 2020, (defined as “COVID-19''). We calculated the total body weight loss percentage (TBWL%) at 3, 6, and 12 months after AOM initiation along with the percentage of patients who achieved a TBWL ³5% and ³10%, after one year of starting an AOM. Our primary endpoint was the TBWL% at 12 months. All tests were two-tailed and p-value <0.05 was considered statistically significant. Values are presented as mean ± standard deviation (SD). Results: A total of 249 patients were included in the analysis (77% female, age 48.8±12.6 years, body-mass index [BMI] 41.9±8.6 kg/m2). There were no differences in baseline characteristics between both groups (Table 1). Fifty-five percent of the patients were prescribed PHEN-TOP, 16% NBSR, and 29% liraglutide. There was a statistical difference in TBWL% between the PreCOVID-19 group compared to the COVID-19 group: 5.3±3.5% vs 4±3.7% (p=0.03) and 9.6±7% vs 6.5±5.3% (p=0.02) at 3 and 12 months, respectively (Fig. 1A). After 1 year follow-up, 53.6% of patients in the COVID-19 group achieved >5% TBWL compared with 75.3% in the PreCOVID-19 group (p=0.04), and 17.9% of patients in the COVID-19 group achieved 105% TBWL compared with 44.7% in the PreCOVID-19 group (p=0.01) (Fig. 1B). Conclusion: This study shows that weight loss outcomes to AOMs were inferior when prescribed during COVID-19 pandemic, compared to the outcomes observed prior to this. Further studies are needed to understand whether this observation is due to changes in care delivery during the pandemic or due to individual factors such as stress, decreased physical activity, remote working, among others.(Table Presented)Table 1. The demographic, antiobesity medications, and weight loss outcome distribution among patients Pre- and COVID-19.(Figure Presented) Figure 1. The weight loss outcomes of patients (Pre and COVID-19) after one year of AOM therapy (A). The distribution of patients (Pre and COVID-19) achieving >5% and >10% TBWL following one year of AOM (B).