SAT681 Obesity Is A Disease. Maximize Positive Patient Outcome With Medical Treatment
Authors: Casula Sabina , Florez Paola Rios , Gonzalez Lisset Oropesa , Molina Janette , Nagpal Vandu , Sawyer Tatiana , Lagari-Libhaber Violet S 
Published: October 2023

Abstract
Disclosure: S. Casula: None. P. Rios Florez: None. L. Oropesa Gonzalez: None. J. Molina: None. V. Nagpal: None. T. Sawyer: None. V.S. Lagari-Libhaber: None.
Objective: Obesity has been recognized as a disease by the American Medical Association since 2013. Despite this, medical treatment is currently offered only to 2% of the patients in the USA. In comparison, 86% of the patients diagnosed with Type 2 Diabetes receive pharmacotherapy. Recent studies suggest that one out of every three Veterans (32.7%) have a BMI &gt;30. As obesity is well known to be associated with multiple comorbidities, programs implementing early recognition and treatment are critical. While dietary counseling, behavioral therapy, and lifestyle changes are important components of obesity management, they are often not enough. Nevertheless, only a minority of these patients are offered weight loss medications. This analysis shows the impact of combining medications with lifestyle modifications at one of the largest VA facilities. Methods: From 2020-2022, a multidisciplinary team comprised of endocrinologists and clinical pharmacists at the Miami VA Healthcare System, implemented a weekly weight management clinic offering medications to all those patients who met clinical criteria and had previously tried and failed lifestyle modifications. A follow up in 3 months was provided to monitor effectiveness and/or side effects. Results: A total of 161 patients were evaluated from November 2020 to October 2022; 67% men and 33% women. The average age was 54 years old, ranging between 31 and 86. 39.1% patients were Black, 60.2% White, 0.6% Asian. 28% of the patients were Hispanic. Comorbidities included T2DM (30%), sleep apnea (37%), osteoarthritis (36%), hypogonadism (5%), dyslipidemia (55%), NASH (22%), and 9% of the women had PCOS. Of the 161 patients, 138 were started on one of the FDA-approved weight loss medications available (Orlistat, Phentermine/Topiramate, Naltrexone/Bupropion, Liraglutide or Semaglutide). 35 patients had side effects from the initial medication and 23 patients had a poor clinical response (less than 5% weight loss). These patients were offered alternative treatment. The number of prescriptions for Phentermine/Topiramate increased from 17 (Nov 2019 to Oct 2020) to 52 (Nov 2020-Oct 2021), and to 67 (Nov 2021-Oct 2022). The prescriptions for Semaglutide (for weight loss as main indication) increased from 18 (Nov 2020-Oct 2021) to 91 (Nov 2021-Oct 2022). Of the 102 patients who were on the same medication for at least 3 months (11.4 months average), on average the BMI decreased by 10.1% (-4.2 kg/m2), and their weight decreased by 9.4% ( -26.2 pounds). 46 patients were on the same treatment for at least 12 months (15.4 months average) and on average their BMI decreased by 10.9% (-4.7 kg/m2), and their weight decreased by 11% (-31.4 pounds). Conclusions: The successful implementation of this clinic highlights the importance of approaching obesity as a disease and incorporating pharmacotherapeutic agents to support weight loss in addition to lifestyle changes.
Presentation: Saturday, June 17, 2023