Real-World Weight Loss Medications in VA System Show Smaller Results Than Clinical Trials | Research

The takeaway

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.

Smaller real-world results
Weight loss and adherence with GLP-1RAs and other WMMs at 37 VA centers fell below clinical trial benchmarks

What the researchers 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.

Why it 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 numbers in context

37 VA medical centers; 6 medications evaluated; weight loss assessed at 3, 6, 12, and >12 months.

How the study worked

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.

Who was studied

Veterans Affairs patients prescribed weight management medications

What this study cannot 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.

How to read the evidence

Moderate evidence — large real-world multi-center evaluation with practical insights, but retrospective design with inherent limitations.

When this study was published

Published in 2024 covering 2020-2022. Captures the early real-world adoption of semaglutide for weight management in the VA system.

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.

Questions still open

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?

Common 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.

Read the original research

Weight management medications for chronic use in 37 veterans affairs medical centers-A medication use evaluation.

Obesity science & practice, 10(5), e70002

View on PubMed ↗Publisher’s paper ↗

Citation

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