It is unknown whether weight loss outcomes differ with metformin monotherapy in patients with obesity with or without type 2 diabetes (T2DM)/prediabetes (PreDM). In this retrospective study, 6- or 12-month weight loss outcomes were compared in 222 patients with or without T2DM/preDM who completed metformin monotherapy. Average weight loss was similar between groups, euglycemic vs. T2DM/preDM (6 months: 6.5 [6.0%] vs. 6.5 [6.1%] p = 0.97; 12 months: 7.4 [6.2%] vs. 7.3 [7.7%], p = 0.92). Categorical weight losses (≥5% and ≥10% of baseline weight) were also similar. Comparable clinically significant weight loss was achieved with metformin monotherapy in patients with obesity with or without T2DM/PreDM.

Abstract Background: Metformin is the first-line pharmacologic treatment for type 2 diabetes (T2DM). Its use has been associated with significant weight loss in patients with obesity with or without T2DM. However, it is unknown whether weight loss outcomes differ with metformin monotherapy in patients with excess weight and euglycemia compared to patients with T2DM/prediabetes (PreDM). Methods: This is a retrospective study of new patients with overweight/obesity seen at an academic weight management center between 4/1/14-4/1/16. Patients who received metformin as a sole pharmacotherapy were identified, and data pertaining to demographics, medications, comorbidities, and weight changes during 1-year follow-up were obtained from their electronic medical records. Mean and categorical weight losses were compared between patients with and without T2DM/PreDM. We also assessed the rate of metformin discontinuation due to side effects, lack of efficacy or other reasons in the entire cohort. Results: Of 1056 patients who were prescribed metformin for weight loss over the 2-year study period and had at least 2 office visits, 99 (9.38%) discontinued the medication due to the following reasons: side effects 59 (60%), lack of efficacy 15(15%) or other reasons 25(25%). A total of 254 patients received metformin as a sole pharmacotherapy for weight loss and had 6 and/or 12-month follow-up visits. In this cohort, the mean age was 53 ± 14 years, 66% were women. The mean BMI was 35 ± 7 kg/m2. The average percent weight loss at 6 and 12 months were similar in patients with euglycemia compared to patients with T2DM/PreDM (6.12% ± 5.68 vs 6.36% ± 6.52 p=0.73 at 6 months; 7.13% ± 6.42 vs 7.23% ± 7.74 p=0.93 at 12 months). The proportion of patients who experienced ≥5% weight loss was similar in both groups at 6-month (54.04 vs 54.55%, p=0.94) and 12-month follow-up visits (63.95 vs 55.42%, p=0.26). The proportion of patients who experienced ≥10% weight loss was also similar in both groups at 6-month (25.81 vs 27.72%, p=0.81) and 12-month follow-up visits (33.72 vs 30.12%, p=0.62). Discussion: Among patients with obesity, metformin as a sole pharmacotherapy for weight loss achieved significant and comparable weight reduction in patients with or without T2DM/PreDM. Further studies are needed to evaluate the long-term weight loss in patients with euglycemia.

ObjectiveThis study aimed to elucidate medical weight‐loss outcomes in patients unexposed or exposed to psychotropic medication(s).MethodsThis retrospective cohort study evaluated weight‐loss outcomes of completers treated at an academic weight‐management center between April 1, 2014, and April 1, 2016. Patients were classified as either unexposed (not prescribed psychotropic medication) or exposed (prescribed psychotropic medication) based on use of antidepressants, mood stabilizers, or antipsychotics during the study.ResultsOf 1,932 patients seen during the study period, 885 were eligible for inclusion, of whom 619 (70.0%) were unexposed and 266 (30.0%) were exposed to psychotropic medications. In the unexposed and exposed groups, the mean age, sex distribution, proportion with type 2 diabetes, initial BMI, and number of weight‐loss medications prescribed were similar. At 12 months, the unexposed group lost 1.6% more weight on average than the exposed group (9.1% [SD 7.6%] vs. 7.5% [SD 8.1%], respectively; P = 0.02); 71.0% and 41.2% of the unexposed group achieved ≥ 5% and ≥ 10% weight loss at 12 months, respectively, compared with 63.1% and 31.8% in the exposed group at 12 months (P = 0.04 at 5%; P = 0.02 at 10%).ConclusionsExposure to psychotropic medications was associated with diminished weight loss in patients with medically managed overweight and obesity.

Background: The efficacy of anti-obesity medications in combination with lifestyle modification is robustly supported by randomized controlled trials, but there is a paucity of data on their effectiveness for weight loss maintenance in clinical practice. Objectives: To investigate real-world effectiveness of anti-obesity medications (AOM) to maintain weight loss over 2 years. Methods: A retrospective chart review of patients who established care at an academic weight management center between 4/2014-4/2016 was performed by three independent reviewers. Patients who had both 1-year and 2-year follow-up appointments were identified. Demographics, medications, and weight changes after pharmacotherapy initiation were recorded during 2-year follow-up. Results: Of 1775 new patients, 883 met eligibility criteria, and 423 patients had weight data recorded at 1-year and 2-year time points. Patients were 74.2% female with an average age of 50.9 + 13.8 years, and 17.0% had type 2 diabetes (T2DM). The mean baseline weight and BMI were 98.6 + 22.5 kg and 35.3 + 6.87 kg/m2, respectively. The mean weight loss at year-1 and year-2 was similar (-9.9 + 7.7% vs. -10.3 + 8.8%, p=0.31). There was no statistically significant difference in weight loss between the T2DM and non-DM cohorts at 2 years (-8.69% vs. -10.48%, p=0.12). The average BMI change at 2 years was -10.7 + 9.4% (p<0.001). Seventy-five percent of patients achieved ≥ 5% weight loss at 1 year, and of these, 87.4% maintained that loss at 2 years. Forty-six percent of patients achieved ≥10% weight loss at 1 year, of which 76.9% maintained that loss at 2 years. At 2 years, 96.2% of patients remained on > 1 weight loss medication with an average of 2.4 + 1.2 drugs. The most commonly prescribed weight-loss pharmacotherapies were metformin (71.5%), phentermine (23.3%) and topiramate (19.9%). Conclusions: Clinically significant weight loss maintenance over 2 years is achievable with the use of multi-drug weight-loss pharmacotherapy in a specialty care center. Disclosure B.G. Tchang: None. M. Aras: None. L. Mandel: None. L.I. Igel: None. R. Kumar: Speaker's Bureau; Self; Janssen Pharmaceuticals, Inc., Novo Nordisk Inc. Stock/Shareholder; Self; VIVUS, Inc., Zafgen, Inc. K.H. Saunders: None. J. Waitman: None. L. Aronne: Advisory Panel; Self; Eisai Inc., Gelesis, Jamieson Wellness Inc., Janssen Pharmaceuticals, Inc., Novo Nordisk Inc., Pfizer Inc., Real Appeal, Inc., UnitedHealth Group Inc. Board Member; Self; BMIQ Professionals Program, Jamieson Wellness Inc., MYOS Corp. Consultant; Self; Eisai Inc., Gelesis, Jamieson Wellness Inc., Janssen Pharmaceuticals, Inc., Novo Nordisk Inc., Real Appeal, Inc., UnitedHealth Group Inc. Research Support; Self; Allurion, Aspire Bariatrics, AstraZeneca, Eisai Inc., Janssen Pharmaceuticals, Inc., Novo Nordisk Inc. Stock/Shareholder; Self; BMIQ Professionals Program, ERX Pharmaceuticals, Inc., Gelesis, Jamieson Wellness Inc., MYOS Corp, Zafgen, Inc. A. Shukla: None.

Background: Obesity and type 2 diabetes mellitus (T2DM) are inextricably linked. Obesity is the pathophysiologic driver of T2DM, and as such, the treatment of obesity can improve glycemic control. Although there is some data from phase 3 trials of anti-obesity pharmacotherapy in patients with T2DM, there is currently a paucity of data related to the weight-centric management of T2DM in clinical practice. Data from clinical trials of these medications suggests that weight loss outcomes in patients with T2DM are inferior, likely due to the weight gain promoting effects of concomitant antidiabetic therapies. Methods: In a retrospective study, electronic medical records of 359 consecutive new patients seen at the Weill Cornell Comprehensive Weight Control Center from 4/1/14-4/1/15 were reviewed and data related to demographics, medications, weight, and HbA1c was recorded. Results: 48 of 359 patients had T2DM. Baseline age and BMI were 56.2±10.6 years and 39.5±7.6 kg/m2 in patients with T2DM and 48±14.7 years and 35.6±6.8 kg/m2 in patients without T2DM; 54.2% and 70.7% were female, respectively. Management strategies in patients with T2DM included the addition and dose escalation of metformin, GLP-1 agonists, and SGLT2 inhibitors, discontinuation of sulfonylureas and TZDs, and dose reduction of insulin when possible. 56.3% of patients with T2DM were started on anti-obesity pharmacotherapy including lorcaserin, phentermine, topiramate and bupropion. At 12 months, weight loss was 8.9±7.8% in patients with T2DM and 8.6±7.7% in those without T2DM. In patients with T2DM, HbA1c was 7.1±1.1% at initial visit and 6.7±1.3% at 12 months. Conclusions: In this review, weight loss outcomes were similar in patients with and without T2DM. We show that by using a weight-centric approach to diabetes management, patients can achieve glycemic control with concomitant weight loss. Disclosure L. Mandel: None. A. Shukla: None. R. Kumar: Speaker's Bureau; Self; Novo Nordisk Inc., Janssen Pharmaceuticals, Inc.. J. Waitman: None. L. Aronne: Board Member; Self; Myos Corporation, Jamieson Wellness. Consultant; Self; Aspire Bariatrics, Eisai Inc., Novo Nordisk Inc.. Research Support; Self; Pfizer Inc.. Consultant; Self; Takeda Pharmaceuticals U.S.A., Inc.. Research Support; Self; Zafgen. Other Relationship; Self; BMIQ, Gelesis, ERX Pharmaceuticals, Inc.. Research Support; Self; AstraZeneca. Consultant; Self; Sanofi, Janssen Pharmaceuticals, Inc., UnitedHealth Group.

The SHAPE (Screened Health Assessment and Pacer Evaluation) trial was a 24 month randomized multicenter placebo‐controlled study to determine the efficacy of an implantable gastric stimulator (IGS) for weight loss. This report is an investigator‐initiated sub‐study at one site designed to assess whether IGS affects plasma levels of ghrelin and peptide YY (PYY). The device was implanted in all subjects but was activated in the Treatment group (n = 7, BMI = 41.5 ± 2.0 kg/m2) and remained inactive in the Control (n = 6, BMI = 39.5 ± 1.7 kg/m2) during the first 12 months. IGS was activated in both groups during months 12–24. Fasting venous blood was drawn at months 0, 12, and 24 and an oral glucose tolerance test (OGTT) was performed at month 12. Although there was no difference in weight loss at 6 months (Control: −6.6 ± 1.5% vs. Treatment: −6.2 ± 1.4%), at 24 months the Control group exhibited weight gain from baseline (+2.2 ± 1.5%) that was significantly different from the weight loss in the Treatment group (−1.9 ± 1.4%; P < 0.05). At 12 months, fasting ghrelin was significantly increased (P < 0.05) in the Treatment group (285 ± 35 to 336 ± 35 pg/ml; weight change, −4.9 ± 1.4%), but not in the Control (211 ± 36 to 208 ± 35 pg/ml; weight change, −3.4 ± 1.5%). No significant change was observed in postprandial suppression of plasma ghrelin or in fasting and postprandial PYY levels. In conclusion, IGS does not prevent the increase in fasting plasma ghrelin levels associated with weight loss. Further studies are needed to determine whether changes in technology can improve weight loss and maintenance, perhaps using gut hormones as biomarkers of possible efficacy.

ObesityVolume 18, Issue S2 p. S204-S204 Free Access Poster Abstracts–Monday, October 11, 2010 First published: 06 September 2012 https://doi.org/10.1038/oby.2010.162AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume18, IssueS2Special Issue: OBESITY 2010 Abstract SupplementNovember 2010Pages S204-S204 RelatedInformation