With the surge in use of glucagon-like peptide 1-receptor agonists (GLP-1RAs) for weight management, “Ozempic Face,” one of the dermatologic effects describing facial hollowing, sinking cheeks, and skin laxity, has drawn public attention. While substantial media discourse has surrounded certain dermatologic effects, patient-reported data is needed to more accurately characterize them. This study identifies patient-reported changes in skin, hair, and nails associated with weight management treatment with GLP-1RAs, including the frequency of dermatologic effects relative to weight loss. Our study was conducted through an IRB-approved, voluntary, anonymous survey developed via collaboration between obesity medicine physicians and dermatologists. The survey was then distributed to patients of a virtual cardio–kidney–metabolic treatment program. Responses (n = 1226) were sorted by the percent body weight lost and categorized by medication regimen (glucagon-like peptide 1-receptor agonists; GLP-1RA, nonGLP-1RA, or combination therapy). Patients reported dermatologic and overall physical changes. Dermatologic effects were reported more frequently with greater weight loss. Of respondents reporting greater than 20

Introduction & Objective: Use of branded anti-obesity medications (bAOMs) has increased concurrently with the rise of telemedicine, a convenient, cost-effective modality for patient care. However, limited data exist regarding characteristics of telemedicine users in medical weight management. This study examines the profile and treatment course of patients prescribed bAOMs for overweight or obesity via telemedicine at an academic weight center in New York City. Methods: This is a retrospective observational study of patients who started telemedicine treatment between May 1, 2020, and September 30, 2022, received a bAOM prescription (Contrave®, Qsymia®, Saxenda®, or Wegovy®), and had ≥6 (±2) months’ follow-up. Data were abstracted by electronic medical record query using relevant ICD/diagnosis codes and biomarker data to curate a dataset of eligible patients for analysis. Results: Patients who met inclusion criteria (N=1286) had a mean age of 47.2 (SD=12.8) years, initial weight of 220.9 (50.6) lb (n=934), initial BMI of 35.2 (6.5) (n=930), and an average of 2.2 weight-related comorbidities (most commonly dyslipidemia [n=705], hypertension [n=355], and prediabetes [n=595]). Most patients identified as White (63.7%); 72.2% of patients were female. Patients had a mean (SD) of 9.5 (7.2) telemedicine visits with physicians, nurse practitioners, and registered dietitians over 17.7 (7.2) months; 36.2% used both telemedicine and in-person visits, and 63.8% used only telemedicine. The most frequently prescribed bAOM was Wegovy® (70.3% of patients), followed by Saxenda® (17.6%), Contrave® (13.6%), and Qsymia® (12.4%). Conclusion: In this study, Wegovy® was the most commonly prescribed bAOM, and telemedicine facilitated frequent appointments (every 1.9 months on average). Future research is necessary to examine the impact of this treatment model on obesity and obesity-related comorbidities. Disclosure A. Shukla: Research Support; Eli Lilly and Company, Novo Nordisk. Consultant; Sun Pharmaceutical Industries Ltd. D. Li: None. A.J. Casper: None. L. Aronne: Advisory Panel; Novo Nordisk. Consultant; Novo Nordisk. Advisory Panel; Lilly Diabetes, Altimmune Inc. Consultant; Lilly Diabetes. Advisory Panel; Pfizer Inc. Consultant; UnitedHealth Group. Advisory Panel; Boehringer-Ingelheim. Board Member; AstraZeneca. Advisory Panel; Amgen Inc. D. D'Angelo: None. K.H. Saunders: Other Relationship; Intellihealth. L.I. Igel: Consultant; Novo Nordisk. Employee; Intellihealth. E. Lucas: Consultant; Intellihealth. K. Palepu: None. E. Zacherle: Employee; Novo Nordisk. A. Traina: Employee; Novo Nordisk. Stock/Shareholder; Novo Nordisk. K. Olsson: Employee; Novo Nordisk.

Objective Recent changes to the Chronic Kidney Disease Epidemiology Collaboration estimated glomerular filtration rate (eGFR) formula (2021 CKD-EPI) removed race from the 2009 formula, increasing the number of Black people classified as having CKD, but these changes may impact eligibility and/or dosing for antiobesity medications. This study estimated the number of people with obesity nationwide who might have pharmacotherapy options impacted by the new formula. Methods Using National Health and Nutrition Examination Survey (NHANES) cohort study data, the number of people eligible for antiobesity medication was estimated, and the number who would require a dosage reduction or would no longer be eligible for specific medications based on the new eGFR formula was also estimated. Results Among 16,412,571 Black and 109,654,751 non-Black people eligible for antiobesity medication, 911,336 (6.1%) Black and 6,925,492 (6.6%) non-Black people had >= CKD stage 3 by the 2009 CKD-EPI formula. Applying the 2021 CKD-EPI formula, 1,260,969 (8.5%) Black people and 4,989,919 (4.7%) non-Black people had >= CKD stage 3. For medications requiring renal adjustment, the number of Black people who would require a lower dose or be precluded from using a medication increased by 24.7% to 50.2%. Conclusions These findings highlight the importance of measuring-rather than estimating-GFR in Black people with CKD when considering many antiobesity pharmacotherapy options.

ObesityVolume 30, Issue 3 p. 573-574 COMMENTARY Telemedicine could be the solution to scaling obesity treatment Katherine H. Saunders, Katherine H. Saunders Comprehensive Weight Control Center, Weill Cornell Medicine, New York, New York, USASearch for more papers by this authorLeon I. Igel, Leon I. Igel Comprehensive Weight Control Center, Weill Cornell Medicine, New York, New York, USASearch for more papers by this authorLouis J. Aronne, Corresponding Author Louis J. Aronne ljaronne@med.cornell.edu Comprehensive Weight Control Center, Weill Cornell Medicine, New York, New York, USA Correspondence Louis J. Aronne, Comprehensive Weight Control Center, Weill Cornell Medicine, New York, NY 10065, USA. Email: ljaronne@med.cornell.eduSearch for more papers by this author Katherine H. Saunders, Katherine H. Saunders Comprehensive Weight Control Center, Weill Cornell Medicine, New York, New York, USASearch for more papers by this authorLeon I. Igel, Leon I. Igel Comprehensive Weight Control Center, Weill Cornell Medicine, New York, New York, USASearch for more papers by this authorLouis J. Aronne, Corresponding Author Louis J. Aronne ljaronne@med.cornell.edu Comprehensive Weight Control Center, Weill Cornell Medicine, New York, New York, USA Correspondence Louis J. Aronne, Comprehensive Weight Control Center, Weill Cornell Medicine, New York, NY 10065, USA. Email: ljaronne@med.cornell.eduSearch for more papers by this author First published: 23 February 2022 https://doi.org/10.1002/oby.23391Read the full textAboutPDF 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. Volume30, Issue3March 2022Pages 573-574 RelatedInformation

Obesity is a chronic disease caused by dysregulated energy homeostasis pathways that encourage the accumulation of adiposity, which in turn results in the development or exacerbation of weight-related comorbidities. Treatment of obesity relies on a foundation of lifestyle modification; weight loss pharmacotherapy, bariatric surgery and devices are additional tools to help patients achieve their health goals. Appropriate management of patients with obesity provides multiple metabolic benefits beyond weight loss.

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.

Background We conducted this study to compare the weight loss outcome of intragastric balloons (IGBs) in conjunction with pharmacotherapy vs IGB and intensive lifestyle changes alone. Methods This was a multicenter, non-randomized, retrospective study involving 4 academic hospitals. Patients underwent IGB placement with or without concomitant anti-obesity pharmacotherapy. The primary outcome was percent total weight loss (TBWL) after IGB placement at 6 and 12 months. Results This study included 102 patients, with 23 patients (mean age 46.6 years, 82.6% female) treated with IGB/pharmacotherapy and 79 patients (mean age 46.0 years, 88.6% female) treated with IGB/lifestyle modifications. Patients had a 100% follow-up rate at 6 and 12 months. At 6 months following IGB placement, both groups achieved a similar %TBWL. At 12 months, %TBWL was greater in the IGB/pharmacotherapy group (12.6% ± 1.2 vs 9.7% ± 0.7, P = .04). 65.2% of patients achieved ≥10% TBWL at 12 months in the IGB/pharmacotherapy group, compared to 38.0% in the IGB/lifestyle group ( P < .05). The proportion of patients that achieved ≥15% weight loss at 12 months was also significantly different between the IGB/pharmacotherapy and IGB/lifestyle groups (30.4% vs 20.3%, P < .05). Discussion IGB with concomitant use of pharmacotherapy did not improve weight loss while the IGB was in place compared to IGB and lifestyle changes. However, patients receiving IGB with pharmacotherapy did have greater weight loss and diminished weight regain after balloon removal compared to those receiving just IGB and lifestyle changes.

BACKGROUND AND AIMS:The growing burden of obesity as a chronic disease necessitates a multifaceted approach to management. There has been an increase in the number of available endoscopic therapies for weight management with endoscopic sleeve gastroplasty (ESG) proving to be one of the best options. The long-term efficacy of ESG for management of obesity is not known. This study sought to assess the long-term safety and efficacy of ESG for treatment of obesity. METHODS:This was a prospective cohort study. Participants underwent ESG in a single academic center, and were prospectively enrolled. All procedures were performed by the same therapeutic endoscopist. Patients with a body mass index of >30 kg/m2 (or >27 with comorbidities), who underwent ESG from August 2013 to August 2019 for treatment of obesity were enrolled. Patients were followed for up to 5 years after their procedure. The primary outcome was weight loss at 5 years after the procedure (% total body weight loss, TBWL) RESULTS: 216 patients (68% female) with a mean age of 46±13 years, and mean BMI of 39±6 kg/m2 underwent ESG. Out of 216 patients, 203, 96, and 68 patients were eligible for a 1-, 3-, and 5-year follow up, with complete follow-up rates of 70%, 71%, and 82%, respectively. At 5 years, mean TBWL was 15.9% (95% CI, 11.7-20.5, p < .001) and 90 and 61% of patients maintained 5 and 10% TBWL, respectively. There was an overall rate of 1.3% moderate adverse events (AEs), without any severe or fatal AEs. CONCLUSIONS:Our results suggest that ESG is safe and effective for treatment of obesity, with durable long-term results for at least up to 5 years after the procedure. This procedure should be considered as a reliable option for treatment of obesity.

A strong association exists between excess weight and obstructive sleep apnea (OSA), and most patients with OSA have elevated body mass index. Weight loss is an essential part of treatment for patients with OSA and overweight or obesity. Lifestyle interventions are cornerstones of weight management. However, most patients have difficulty achieving and maintaining clinically significant weight loss with lifestyle interventions alone. Health care providers who treat patients with OSA should be familiar with advanced treatment options for overweight and obesity including antiobesity medications, bariatric surgery, and devices. The future of weight management is a customized, multidisciplinary approach for each patient.

This randomized, double-blind, placebo-controlled, n-of-1 crossover study assessed whether metformin's side effects are reproducible in patients with a history of metformin intolerance. Participants completed up to four cycles of 2 weeks of metformin exposure and 2 weeks of placebo exposure. Participants completed surveys based on the Gastrointestinal Symptom Rating Scale and the Treatment Satisfaction Questionnaire for Medication. The primary hypotheses were that treatment satisfaction would be equal for placebo and metformin and that more than 30% of the study enrollees would be able to adhere to a higher dose of metformin 6 months after participation. Thirteen patients (all women, mean age 52.4 years) enrolled, three of whom were lost to follow-up or were non-adherent to study protocol. Metformin was associated with significantly lower global treatment satisfaction scores compared with placebo (39.58 vs. 53.75,P< .05 ) but participants could not distinguish metformin from placebo and did not report higher rates of gastrointestinal side effects on metformin. Two out of 10 participants adhered to a higher dose of metformin after trial completion. Metformin appears to have barriers to use beyond its classic gastrointestinal side effects.

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.

Objective Obesity Medicine Education Collaborative (OMEC) was formed to develop obesity-focused competencies and benchmarks that can be used by undergraduate and graduate medical education program directors. This article describes the developmental process used to create the competencies. Methods Fifteen professional organizations with an interest in obesity collaborated to form OMEC. Using the six Core Competencies of the Accreditation Council for Graduate Medical Education as domains and as a guiding framework, a total of 36 group members collaborated by in-person meetings, email exchange, and conference calls. An iterative process was used by each working subgroup to develop the competencies and assessment benchmarks. The initial work was subsequently externally reviewed by 19 professional organizations. Results Thirty-two competencies were developed across the six domains. Each competency contains five descriptive measurement benchmarks for evaluator rating. Conclusions This set of OMEC obesity-focused competencies is the first evaluation tool developed to be used within undergraduate and graduate medical training programs for both formative and summative assessments. Routine and more robust assessment is expected to increase the competence of health care providers to assess, prevent, and treat obesity. In addition to dissemination, the competencies and benchmarks will need to undergo evaluation for further validity and practicality.

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.

10 diagnosed with functional diarrhoea (FD).This study was approved by University of Otago Human Ethics Committee (Reference H16/094).Faecal samples were analysed by shotgun sequenced using the Illumina NextSeq platform.Taxonomic classifications were determined using Metaxa2 and the SILVA 128 database.Gene functions were assigned by alignment of sequences against a protein reference database using DIAMOND and functional classification using MEGAN.Plasma was prepared using a biphasic extraction method and lipidome profiling performed using liquid chromatography high resolution mass spectrometry analysis (LC-MS/MS).Lipids were identified using the LipidSearch and LipidBlast databases.Integrated analysis of the faecal microbiome and plasma lipidome was performed using canonical correlation analysis.Results: Canonical correlation analysis revealed associations (r>0.5) between numerous plasma lipids (e.g.diradylglycerolipids, triradylglycerolipids, and phosphatidylethanolamines) with the faecal microbe Blautia and a group of unclassified Lachnospiracae, of which Blautia is a member.These two taxa were a major component of the microbiome, collectively accounting for >25% of the community.Similarly, correlations (r>0.7) were observed between plasma lipids and microbial genes involved in lipid and carbohydrate metabolism, including glyoxylate and dicarboxylate metabolism, and glycerolipid metabolism.Conclusion: Our results show potential links between major members of the faecal microbiome, in both composition and function, with the plasma lipidome profile in an IBS cohort.Although further study is required to ascertain cause and effect relationships, our study provides an important first step for achieving a system-wide understanding of how the microbiome impacts human health in IBS.

Data suggest that nutrient order during a meal significantly impacts postprandial glucose and insulin excursions in type 2 diabetes, while its effects in prediabetes have not been reported. Fifteen participants with prediabetes consumed the same meal on 3 days in random order: carbohydrate first, followed 10 minutes later by protein and vegetables (CF); protein and vegetables first, followed 10 minutes later by carbohydrate (PVF); or vegetables first followed by protein and carbohydrate (VF). Blood was sampled for glucose and insulin measurements at 0, 30, 60, 90, 120, 150 and 180 minutes. Incremental glucose peaks were similarly attenuated by >40% in the PVF and VF meal conditions compared with CF. The incremental area under the curve for glucose was 38.8% lower following the PVF meal order, compared with CF, and postprandial insulin excursions were significantly lower in the VF meal condition compared with CF. The CF meal pattern showed marked glycaemic variability whereas glucose levels were stable in the PVF and VF meal conditions. Food order presents a novel, simple behavioural strategy to reduce glycaemic excursions in prediabetes.