Primary-care strategies to enhance weight management after discontinuation of anti-obesity medications - PROJECT SUMMARY The use of anti-obesity medications (AOMs) is rapidly increasing, driven by the approval of newer incretin- based treatments, including both GLP-1 receptor agonists and combination GLP-1/GIP receptor agonists. Despite their efficacy, discontinuation rates for these medications are high, and stopping treatment often leads to rapid and significant weight regain. Intervening with behavioral intervention after AOM discontinuation may reduce the steep regain curve. However, it is currently unclear how to engage with these patients quickly to improve long-term weight management and health benefits. Primary care clinics are essential settings for intervention after AOM discontinuation because primary care providers frequently treat obesity and prescribe AOMs. Unfortunately, there is little evidence to suggest that patients receiving obesity treatment in primary care settings have access to behavioral support to accompany AOMs discontinuation. The long-term goal of this research is to develop a weight management treatment program for individuals discontinuing AOMs that can be widely implemented in primary care. In this feasibility project, we will leverage the EHR and a low- burden self-reporting method to track the natural progression of AOM use and discontinuation in primary care patients prescribed AOMs. We will use this system as the foundation of a primary care-based program that quickly identifies patients who discontinue their medication and enrolls them into a behavioral weight management program. The behavioral weight management program being evaluated in this project is specifically designed to enhance weight management following discontinuation of AOMs. A unique component of the program is its emphasis on reducing food cue reactivity, a specific issue of concern for those discontinuing AOMs. The program will be a self-tailored, automated program paired with remote patient monitoring of weight change. In response to PAS-23-086, this program will be evaluated in a 6-month, two-arm feasibility study (N = 90) compared to a usual care arm. Outcomes of interest will be 1) feasibility of recruitment, 2) acceptability of the program, and 3) documenting the efficiency of study processes. We will conduct key informant interviews with providers and clinic staff to guide future implementation efforts. The completion of the study will provide strong preliminary data for a future application that will propose a fully powered, hybrid trial (type 1) evaluating the efficacy and initial implementation strategies of this comprehensive primary care-based obesity management program. This line of research has the potential to offer pivotal insights into best practices for long-term weight management after AOM discontinuation and bridge the gap between pharmacological and behavioral strategies for obesity management in primary care.
