Real-World Weight Loss Medications in VA System Show Smaller Results Than Clinical Trials
A medication use evaluation across 37 VA medical centers found semaglutide, phentermine/topiramate, and orlistat were most prescribed, with smaller weight loss and higher discontinuation rates than clinical trials reported.
Quick Facts
What This Study Found
Real-world weight loss with GLP-1RAs (semaglutide, liraglutide) and other weight management medications at 37 VA centers was smaller than clinical trials, with higher discontinuation rates and barriers including drug shortages.
Key Numbers
37 VA medical centers; 6 medications evaluated; weight loss assessed at 3, 6, 12, and >12 months.
How They Did This
Retrospective, cross-sectional medication use evaluation using electronic health records from 37 VA Medical Centers (March 2020 - March 2022). 1,959 veterans newly initiated on WMMs. Weight loss tracked at 3, 6, 12, and 12+ months.
Why This Research Matters
Clinical trials select ideal patients and ensure compliance. This real-world data shows what actually happens when weight loss drugs are prescribed to a diverse veteran population — providing pragmatic expectations for clinicians and patients.
The Bigger Picture
As GLP-1 drugs become the dominant weight management approach, understanding real-world performance gaps is essential for health system planning. The VA data reveals that drug shortages, patient factors, and system barriers significantly attenuate the impressive results seen in trials.
What This Study Doesn't Tell Us
Retrospective chart review — adherence and dosing may be inconsistently documented. VA population skews male and older. COVID-19 pandemic period may have affected results. Drug shortages during study period limited semaglutide access. No comparison to non-pharmacological weight management.
Questions This Raises
- ?Will newer GLP-1 drugs (tirzepatide) perform closer to clinical trial results in real-world VA settings?
- ?What interventions could close the gap between trial and real-world weight loss outcomes?
- ?Should VA prescribing criteria be modified to improve access and outcomes?
Trust & Context
- Key Stat:
- Smaller real-world results Weight loss and adherence with GLP-1RAs and other WMMs at 37 VA centers fell below clinical trial benchmarks
- Evidence Grade:
- Moderate evidence — large real-world multi-center evaluation with practical insights, but retrospective design with inherent limitations.
- Study Age:
- Published in 2024 covering 2020-2022. Captures the early real-world adoption of semaglutide for weight management in the VA system.
- Original Title:
- Weight management medications for chronic use in 37 veterans affairs medical centers-A medication use evaluation.
- Published In:
- Obesity science & practice, 10(5), e70002 (2024)
- Authors:
- Walczuk, Samantha, Burk, Muriel, Furmaga, Elaine, Ghassemi, Samaneh, McCarren, Madeline, Bukowski, Kenneth, Glassman, Peter, Cunningham, Fran
- Database ID:
- RPEP-09458
Evidence Hierarchy
Frequently Asked Questions
Do weight loss drugs work as well in real life as in clinical trials?
Not quite — this study of nearly 2,000 veterans found that weight loss was smaller and more people stopped taking their medications compared to clinical trial results. Barriers like drug shortages, side effects, and personal preferences all contributed to the gap.
Which weight loss medication works best?
In this VA study, phentermine/topiramate, liraglutide, and semaglutide had the highest rates of clinically meaningful weight loss (5% or more). However, real-world results varied significantly from patient to patient. The best medication depends on individual factors, side effect tolerance, and what's available.
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Cite This Study
https://rethinkpeptides.com/research/RPEP-09458APA
Walczuk, Samantha; Burk, Muriel; Furmaga, Elaine; Ghassemi, Samaneh; McCarren, Madeline; Bukowski, Kenneth; Glassman, Peter; Cunningham, Fran. (2024). Weight management medications for chronic use in 37 veterans affairs medical centers-A medication use evaluation.. Obesity science & practice, 10(5), e70002. https://doi.org/10.1002/osp4.70002
MLA
Walczuk, Samantha, et al. "Weight management medications for chronic use in 37 veterans affairs medical centers-A medication use evaluation.." Obesity science & practice, 2024. https://doi.org/10.1002/osp4.70002
RethinkPeptides
RethinkPeptides Research Database. "Weight management medications for chronic use in 37 veterans..." RPEP-09458. Retrieved from https://rethinkpeptides.com/research/walczuk-2024-weight-management-medications-for
Access the Original Study
Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkPeptides research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.