Comparative Effectiveness and Stakeholder Perspectives with Anti-Obesity Medications

About This Grant

Significance to VA Obesity is present among 41% of VA patients and incurs many physical and mental health problems, increases mortality, and accounts for a large share of health care spending. Despite significant VA investment in the MOVE! behavioral intervention program and availability of bariatric surgery, obesity rates in VA remain high. Anti-obesity medications (AOMs) can result in clinically meaningful weight loss and are recommended as part of a comprehensive obesity treatment plan. The newer AOMs offer unprecedented effectiveness and tolerability with few contraindications. AOM use in VA is thus rapidly increasing and the potential impact on Veteran health is considerable. But strategic use of AOMs for Veterans with obesity is hindered by gaps in real-world data about use, clinical outcomes, and patient and clinician perspectives. We will provide the evidence for more strategic AOM use to treat obesity in VA, aligned with VA priorities of Evidence Based Decisions and Data as a Strategic Asset; the VHA Long-Range Goals of “providing health care-related data that benefits Veterans and the general public”, and the HSR priority of “Connect Veterans to the…best care (optimize Veteran access…and experience)”. Innovation & Impact We will assess new AOMs at a time of accelerating Veteran demand, provide the first rigorous evidence of AOM use and outcomes in men, examine weight change and clinical outcomes in real-world practice to complement trial evidence, and provide an in-depth understanding of patient, clinician, and organizational leadership perspectives on AOM use and continuation. Specific Aims Aim 1: Evaluate Veteran, clinician, facility, and VISN characteristics associated with using anti-obesity medications (AOMs) in 2021-2024 and characterize duration and rates of discontinuation. H: AOM users will have different baseline weight, race/ethnicity, and comorbidities than non-users. Aim 2: Compare real-world outcomes of AOM users and non-users in 2021-2024. H: AOM initiators will have greater weight loss and cardiometabolic changes than Veterans who do not initiate AOMs. Weight loss, GI adverse effects, and cardiometabolic changes will differ across AOMs. Aim 3: Characterize factors influencing decisions to initiate and continue AOMs as part of comprehensive obesity treatment, via qualitative interviews with Veterans, clinicians and pharmacy leaders. Methodology This is a sequential explanatory mixed-methods study. Aims 1 and 2 use a retrospective comparative effectiveness study design to examine use and outcomes of AOMs. Aim 3 will use qualitative interviews with patients (N=24), clinicians (N=24), and pharmacy leaders (N=24) to explore decision-making and the reasons for observed patterns of use. The quantitative and qualitative phases will be connected by our use of Aim 1 findings to inform Aim 3 sampling for interviews, and in Aim 3 we will also explore how Aim 2 outcomes influence decisions about continued use. We will use the qualitative data to enhance and enrich understanding of the quantitative findings about AOMs through synthesis of findings across Aims. Path to Translation/Implementation Operational partners in VA Pharmacy Benefits Management and the VHA National Center for Health Promotion and Disease Prevention, which manages MOVE!, will use our findings to inform prescribing guidance and program materials. Our team's next step will be to build on this study to develop and test an intervention to support AOM use among those Veterans that are most likely to benefit in terms of clinical and quality of life outcomes, which will in turn optimize VA resources and maximize Veteran benefit.