Search

Objective: Obesity rates in the United Kingdom are some of the highest in Western Europe, with considerable clinical and societal impacts. Obesity is associated with type 2 diabetes (T2D), osteoarthritis, cardiovascular disease, and increased mortality; however, relatively few studies have examined the occurrence of multiple obesity-related outcomes in the same patient population. This study was designed to examine the associations between body mass index (BMI) and a broad range of obesity-related conditions in the same large cohort from a UK-representative primary care database., Methods: Demographic data and diagnosis codes were extracted from the Clinical Practice Research Datalink GOLD database in January 2019. Adults registered for ≥ 3 years were grouped by BMI, with BMI 18.5-24.9 kg/m 2 as reference group. Associations between BMI and 12 obesity-related outcomes were estimated using Cox proportional hazard models, adjusted for age, sex, and smoking., Results: More than 2.9 million individuals were included in the analyses and were followed up for occurrence of relevant outcomes for a median of 11.4 years during the study period. Generally, there was a stepwise increase in risk of all outcomes with higher BMI. Individuals with BMI 40.0-45.0 kg/m 2 were at particularly high risk of sleep apnea (hazard ratio [95% confidence interval] vs. reference group: 19.8 [18.9-20.8]), T2D (12.4 [12.1-12.7]), heart failure (3.46 [3.35-3.57]), and hypertension (3.21 [3.15-3.26])., Conclusions: This study substantiates evidence linking higher BMI to higher risk of a range of serious health conditions, in a large, representative UK cohort. By focusing on obesity-related conditions, this demonstrates the wider clinical impact and the healthcare burden of obesity, and highlights the vital importance of management, treatment approaches, and public health programs to mitigate the impact of this disease., Competing Interests: Christiane L. Haase, Kirsten T. Eriksen, Sandra Lopes, Altynai Satylganova and Volker Schnecke are employees of Novo Nordisk A/S. Altynai Satylganova and Sandra Lopes are also shareholders of Novo Nordisk A/S. Phil McEwan is an employee of Health Economics and Outcomes Research Ltd. Phil McEwan did not receive funding for this collaboration. HEOR Ltd have received funding from Novo Nordisk A/S for work conducted on previous studies., (© 2020 The Authors. Obesity Science & Practice published by World Obesity and The Obesity Society and John Wiley & Sons Ltd.)

Objective: Previous studies using longitudinal weight data to characterize obesity are based on populations of limited size and mostly include individuals of all body mass index (BMI) levels, without focusing on weight changes among people with obesity. This study aimed to identify BMI trajectories over 5 years in a large population with obesity, and to determine the trajectories' association with mortality., Methods: For inclusion, individuals aged 30-74 years at index date (1 January 2013) with continuous membership in Clalit Health Services from 2008 to 2012 were required to have ≥1 BMI measurement per year in ≥3 calendar years during this period, of which at least one was ≥30 kg/m 2 . Latent class analysis was used to generate BMI trajectories over 5 years (2008-2012). Cox proportional hazards models were used to assess the association between BMI trajectories and all-cause mortality during follow-up (2013-2017)., Results: In total, 367,141 individuals met all inclusion criteria. Mean age was 57.2 years; 41% were men. The optimal model was a quadratic model with four classes of BMI clusters. Most individuals (90.0%) had stable high BMI over time. Individuals in this cluster had significantly lower mortality than individuals in the other trajectory clusters ( p  < 0.01), including clusters of people with dynamic weight trajectories., Conclusions: The results of the current study show that people with stable high weight had the lowest mortality of all four BMI trajectories identified. These findings help to expand the scientific understanding of the impact that weight trajectories have on health outcomes, while demonstrating the challenges of discerning the cumulative effects of obesity and weight change, and suggest that dynamic historical measures of BMI should be considered when assessing patients' future risk of obesity-related morbidity and mortality, and when choosing a treatment strategy., Competing Interests: Christiane Lundegaard Haase, Nick Finer and Altynai Satylganova are employees of Novo Nordisk A/S, and Nick Finer and Altynai Satylganova are shareholders of Novo Nordisk A/S. Morton Leibowitz is an employee of Clalit Research Institute. Orna Reges was an employee of Clalit Research Institute at the time of the analysis and is now a post‐doctoral research fellow at the Northwestern University, Chicago. Tomas Karpati was an employee of Clalit Research Institute at the time of the analysis and is now an employee of the Holon Institute of Technology. Dror Dicker is an employee of Hasharon Hospital, Petach Tikva, and Tel Aviv University. Becca Feldman was an employee of Clalit Research Institute at the time the analyses were conducted., (© 2020 The Authors. Obesity Science & Practice published by World Obesity and The Obesity Society and John Wiley & Sons Ltd.)

Objective: Liraglutide 3.0 mg is associated with clinically significant weight loss in clinical trials, but real-world data are lacking. In this analysis, weight loss and persistence outcomes with liraglutide 3.0 mg were assessed across obesity classes, in a real-world clinical setting., Methods: Secondary analysis of an observational, retrospective study of liraglutide 3.0 mg for weight management (as adjunct to diet and exercise) at six Wharton Medical Clinics in Canada. Patients were categorized by body mass index (BMI, kg/m 2 ) into obesity class I (BMI 30-34.9); class II (BMI 35-39.9); and class III (BMI ≥40). Change in weight, categorical weight loss, time to maintenance dose (defined as the time to reach the full liraglutide 3.0 mg maintenance dose) and persistence were assessed for each class and for differences between classes., Results: Of 308 patients, 70 (22.7%) had obesity class I, 83 (26.9%) obesity class II and 155 (50.3%) obesity class III. Similar percentage change in weight was observed between obesity classes (mean [standard deviation, SD]: -7.0% [6.0], -6.6% [6.0] and -6.1% [5.0], respectively; p = .640), and similar proportions achieved ≥5% weight loss (60.4%, 62.0% and 55.3%, respectively; p = .717) at 6 months. Mean time to maintenance dose (SD) was 64.2 (56.4) d, 76.4 (56.3) d and 71.4 (54.5) d for obesity classes I, II and III, respectively ( p = .509). Persistence with medication was also similar between obesity classes ( p = .358)., Conclusions: These findings suggest that real-world treatment with liraglutide 3.0 mg, regardless of obesity class, is associated with similar clinically significant weight loss, time to maintenance dose and medication persistence., Competing Interests: S.W.: owner and medical director of the Wharton Medical Clinic (WMC) and internal medicine specialist at Hamilton Health Sciences. He has previously received funding in the forms of grants for research from CIHR and Mitacs and also received funding in the past from Novo Nordisk, Bausch Health, Eli Lilly, Janssen and AstraZeneca for advisory work.C.L.H.: employee of Novo Nordisk A/S, Copenhagen, Denmark.E.K.: research coordinator at WMC and a member of this working group.A.L.: employee of Novo Nordisk Canada Inc.J.M.: employee of IQVIA Solutions Canada Inc., responsible for the study (management, analysis and dissemination).D.N.: employee of IQVIA Solutions Canada Inc., responsible for the study (management, analysis and dissemination).A.P.: employee of Novo Nordisk A/S, Copenhagen, Denmark.G.S.P.: employee of IQVIA Solutions Canada Inc., responsible for the study (management, analysis and dissemination).R.A.G.C. was an employee of WMC at the time of this study and is a member of this working group., (© 2020 The Authors. Obesity Science & Practice published by World Obesity and The Obesity Society and John Wiley & Sons Ltd.)

Objective: Weight management medications can significantly increase patients' chances of achieving a clinically meaningful weight loss if patients persist with treatment. This retrospective observational study of de-identified medical records of 311 patients is the first real-world study examining persistence with liraglutide 3.0 mg in Canada, and also investigates associations between the SaxendaCare® patient support program and persistence and weight loss., Methods: Overall persistence was assessed, as well as associations of enrollment in SaxendaCare®, persistence and weight loss., Results: Overall mean (standard deviation) persistence with liraglutide 3.0 mg was 6.3 (4.1) months, and 67.5% ( n = 210) and 53.7% ( n = 167) of patients persisted for ≥4 and ≥ 6 months, respectively. Enrollment in SaxendaCare® was associated with significantly longer persistence with liraglutide 3.0 mg and greater weight loss. Patients enrolled in SaxendaCare® ( n = 119) persisted for 7.9 (4.0) versus 5.2 (3.8) months for those not enrolled ( n = 184) ( p < 0.001), and had significantly greater percent weight loss after 6 months regardless of the duration of their persistence (-7.9% vs -5.5% from baseline, p < 0.01)., Conclusions: These findings suggest that, in clinical settings, persistence with liraglutide 3.0 mg can exceed 6 months, and that enrolling in SaxendaCare® may be associated with comparatively longer persistence and, regardless of persistence, greater weight loss., Competing Interests: Sean Wharton: owner and medical director of the Wharton Medical Clinic (WMC), and internal medicine specialist at Hamilton Health Sciences. He has previously received research grants from Canadian Institutes of Health Research (CIHR) and Mitacs; previous funding from Novo Nordisk, Bausch Health, Eli Lilly, Janssen and AstraZeneca for advisory work.Christiane Lundegaard Haase: employee of Novo Nordisk A/S.Elham Kamran: research coordinator at WMC, and a member of this working group.Aiden Liu: employee of Novo Nordisk Canada Inc.Johanna Mancini: employee of IQVIA Solutions Canada Inc.Drew Neish: employee of IQVIA Solutions Canada Inc.Arash Pakseresht: employee of Novo Nordisk A/S.G. Sarah Power: employee of IQVIA Solutions Canada Inc.Rebecca A.G. Christensen: employee of WMC at the time of this study., (© 2020 The Authors. Obesity Science & Practice published by World Obesity and The Obesity Society and John Wiley & Sons Ltd.)