Background: The care of people with obesity is often suboptimal due to both physician and patient perceptions about obesity itself and clinical barriers. Using data from the ACTION-IO study, we aimed to identify factors that might improve the quality of obesity care through adoption of the 3D approach (Discussion, Diagnosis and Direction [follow-up]) by healthcare professionals (HCPs). Methods: An online survey was completed by HCPs in 11 countries. Exploratory beta regression analyses identified independent variables associated with each component of the 3D approach. Results: Data from 2,331 HCPs were included in the statistical models. HCPs were significantly more likely to initiate weight discussions and inform patients of obesity diagnoses, respectively, if (odds ratio [95% confidence interval]): they recorded an obesity diagnosis in their patient's medical notes (1.59, [1.43-1.76] and 2.16 [1.94-2.40], respectively); and they were comfortable discussing weight with their patients (1.53 [1.39-1.69] and 1.15 [1.04-1.27]). HCPs who reported feeling motivated to help their patients lose weight were also more likely to initiate discussions (1.36 [1.21-1.53]) and schedule follow-up appointments (1.21 [1.06-1.38]). By contrast, HCPs who lacked advanced formal training in obesity management were less likely to inform patients of obesity diagnoses (0.83 [0.74-0.92]) or schedule follow-up appointments (0.69 [0.62-0.78]). Conclusion: Specific actions that could improve obesity care through the 3D approach include: encouraging HCPs to record an obesity diagnosis; providing tools to help HCPs feel more comfortable initiating weight discussions; and provision of training in obesity management. Clinical trial registration: NCT03584191.

Background: People with obesity (PwO) often struggle to achieve and maintain weight loss. This can perpetuate and/or be influenced by feelings of low motivation. This analysis from ACTION-IO data identified factors associated with PwO motivation to lose weight. Methods: PwO completed an online survey in 11 countries. Exploratory multinomial logistic regression analyses identified independent variables associated with self-report of feeling motivated versus not motivated to lose weight. Results: Data from 10,854 PwO were included (5,369 motivated; 3,312 neutral; 2,173 not motivated). Variables associated with feeling motivated versus not motivated included (odds ratio [95% confidence interval]): acknowledgement of healthcare professional (HCP) responsibility to contribute to weight loss (2.32 [1.86-2.88]), comfort in talking to their HCP about weight (1.46 [1.24-1.72), agreement that it is easy to lose weight (1.73 [1.30-2.31]), and a goal of reducing risks from excess weight (1.45 [1.22-1.73]). Conversely, if PwO considered obesity less important than other diseases they were less likely to report feeling motivated (0.49 [0.41-0.58]). PwO who reported being motivated to lose weight were more likely to exercise >= 5 times a week versus <1 time a week (2.77 [2.09-3.68]) than those who reported they were not motivated. Conclusions: Positive interactions with HCPs, self-efficacy, setting goals and knowledge of the importance of weight management, in addition to regular exercising, may increase PwO motivation for weight loss. Appropriate HCP support may help PwO who are ready to engage in weight management. Clinical trial registration: : NCT03584191.

Aims: In people with obesity (PwO), body weight loss of ≥5% is generally considered to be clinically meaningful. Some PwO do receive treatment and guidance from healthcare professionals (HCPs), but there remains a substantial unmet medical outcomes and weight maintenance need. To identify aspects that might contribute to a successful weight loss outcome (WLO; ≥5% body weight loss maintained for ≥1 year), we investigated the characteristics and experience of PwO with and without successful WLOs using data from the ACTION-IO study (NCT03584191). Methods: An online survey was completed by adults with obesity and HCPs in 11 countries: Australia, Chile, Israel, Italy, Japan, Mexico, Saudi Arabia, South Korea, Spain, UAE and UK. A successful WLO was defined as ≥5% body weight loss in the past 3 years maintained for ≥1 year. Results: A total of 14,502 PwO completed the survey. General characteristics were similar between those who had a successful WLO (n=1,559; 11%) vs those who had not (n=12,943; 89%): 53% vs 52% were male; the mean age was 49 vs 48 years; the mean number of comorbidities was 2.0 vs 1.8. The mean number of serious weight loss attempts was 4 for both groups. However, more PwO who had a successful WLO weighed themselves every day (20%) compared with those who had not had a successful WLO (10%). In terms of interactions with HCPs, more PwO who had a successful WLO had discussed weight (58%) with an HCP within the past 5 years than those who did not have a successful WLO (53%). In addition, more PwO who had a successful WLO compared with those who did not had been diagnosed with obesity (42% vs 35%) and had subsequent direction through the scheduling of a follow-up appointment (25% vs 21%). Conclusions: A 3D approach from HCPs (diagnosis, discussion and direction) appears to be a key element in facilitating a successful WLO. Neither gender, nor age, nor number of weight loss attempts was associated with a successful WLO.

In both randomized controlled trials and real-world studies, liraglutide has demonstrated glycemic and body weight benefits in patients with type 2 diabetes. However, persistence with diabetes medication can be challenging. This study compared glycated hemoglobin (HbA1c) and other outcomes in patients with type 2 diabetes who continued treatment with liraglutide for over 12 months with those who discontinued treatment earlier, in a real-life setting. This is a retrospective study of adult patients with type 2 diabetes from Maccabi Healthcare Services in Israel, who initiated treatment with liraglutide from 2010 to 2015. Mean HbA1c and body weight change from initiation to after 24 months was compared between patients who received liraglutide for at least 12 months (“continuers”) and those who discontinued within the first year (“discontinuers”). Adjustment for HbA1c, body weight, and other potentially confounding factors was performed using 1:1 propensity score matching. The 3580 patients comprised 2695 continuers and 885 discontinuers; 882 patients per group were matched. A significant (p < 0.001) reduction in HbA1c (– 0.80% vs – 0.32%) was seen in continuers compared with discontinuers, despite higher insulin usage (70.2% vs 59.0%; p < 0.001), and a higher proportion of patients using ≥ 3 oral glucose-lowering drugs (20.6% vs 6.2%; p < 0.001) at 24 months among discontinuers. Mean body weight reduction was greater in continuers than discontinuers (3.57 vs 1.25 kg; p < 0.001). In a real-world setting, persistent use of liraglutide was associated with good glycemic and body weight control. Novo Nordisk Health Care AG.

Despite increased recognition as a chronic disease, obesity remains greatly underdiagnosed and undertreated. We aimed to identify international perceptions, attitudes, behaviours and barriers to effective obesity care in people with obesity (PwO) and healthcare professionals (HCPs).

Objective: In both randomized, controlled trials and real-world studies, liraglutide (Victoza®) has demonstrated glycemic and body weight benefits in patients with type 2 diabetes mellitus (T2DM). To achieve long-term beneficial outcomes, persistence with treatment is important; however, this can be challenging with injectable drugs. In this study, we examined the association of long-term adherence to liraglutide and metabolic changes. Methods: A retrospective analysis of patients with T2DM (≥18 years old) from Maccabi Healthcare Services, Israel, who initiated liraglutide from 2010-2015 and had HbA1c measurements at treatment initiation and after 24 months. Mean change in HbA1c and body weight from initiation to 24 months was compared between patients who received liraglutide regularly for at least 12 months (’continuers’) and those who discontinued liraglutide before 12 months (’discontinuers’). Patients who were treated with another GLP-1 receptor agonist, or who underwent bariatric surgery, were excluded. Adjustment for potential confounding factors (sex, age, years in diabetes registry, HbA1c, body mass index, and insulin use at treatment start) was performed using propensity score matching (1:1 [n=882 in each group]). Results: Significant reductions in HbA1c were seen in continuers compared with discontinuers (0.80% vs. 0.32%, p<0.0001), despite more using insulin (70.2% vs. 59.0%, p<0.0001) and ≥3 oral antihyperglycemic drugs (20.6% vs. 6.2%, p<0.0001) among discontinuers (in the 3 months preceding the last measurement). Mean body weight reduction was higher in continuers than in discontinuers (3.57 kg vs. 1.25 kg; p<0.0001), but no statistically significant differences were observed in low-density lipoprotein cholesterol (5.72 vs. 2.83 mg/dl [p=0.4717]) and triglycerides (10.37 vs. 6.89 mg/dl [p=0.7896]). Conclusion: In a real-world setting, persistent use of liraglutide was associated with good glycemic and body weight control. Disclosure C. Melzer Cohen: None. G. Chodick: None. L.N. Husemoen: Employee; Self; Novo Nordisk A/S. N. Rhee: Employee; Self; Novo Nordisk A/S. V. Shalev: None. A. Karasik: Stock/Shareholder; Self; Novo Nordisk A/S. Research Support; Self; Novo Nordisk A/S. Advisory Panel; Self; Novo Nordisk A/S, AstraZeneca. Research Support; Self; AstraZeneca. Consultant; Self; Boehringer Ingelheim GmbH. Advisory Panel; Self; Merck & Co., Inc., GlucoMe.