Twelve‐month analysis of real‐world evidence from a telehealth obesity‐treatment provider using antiobesity medications

Abstract

Objective

The objective of this study was to describe weight changes in members of a large‐scale telehealth obesity‐treatment provider who were using antiobesity medications (AOMs).

Methods

This retrospective observational study analyzed real‐world data from adults who initiated AOM treatment with the WeightWatchers (WW) Clinic telehealth program between January 2022 and July 2023 (n = 53,590). The main outcomes were changes in body weight over 12 months, side effects over follow‐up, and medication usage patterns.

Results

The 53,590 patients who initiated treatment were predominantly female (88.6%), with a mean BMI of 36.9 kg/m². Mean (SD) treatment duration was 5.3 (4.3) months. Program retention rates based on the number of patients whose time from enrollment was at least 3, 6, 9, and 12 months were 78% (n = 39,907/51,247), 63% (n = 25,515/40,203), 58% (n = 15,472/26,794), and 77% (n = 6459/8394), respectively. Average weight loss was 8.9% at 3 months (n = 37,565), 14.1% at 6 months (n = 24,140), 17.7% at 9 months (n = 15,169), and 19.4% at 12 months (n = 6089). Glucagon‐like peptide‐1 receptor agonist (GLP‐1‐RA)‐based treatments were predominant. Side effects were consistent with the classes of medications used, and frequency declined over time.

Conclusions

This real‐world analysis of a telehealth‐delivered obesity‐treatment program demonstrated outcomes consistent with recent phase 3 clinical trials of AOMs, suggesting generalizability beyond clinical trial and in‐person settings.

Study Importance.

What is already known?

• Telehealth for obesity treatment has many advantages, particularly as new antiobesity medications (AOMs) increase treatment demand.

• However, there has been scant research on the effectiveness of large‐scale telehealth obesity treatment.

What does this study add?

• Average weight loss across AOMs at a large‐scale telehealth obesity clinic was 8.9% at 3 months, 14.1% at 6 months, 17.7% at 9 months, and 19.4% at 12 months.

• Side effects were consistent with the classes of medications used, and frequency declined over time.

How might these results change the direction of research or the focus of clinical practice?

• Telehealth‐delivered treatment of obesity that includes current AOMs appears to produce comparable results with those seen in phase 3 clinical trials, suggesting that the results can be generalized beyond clinical trial and in‐person settings.

INTRODUCTION

It has been estimated that nearly 50% of adults in the United States are actively trying to lose weight [1]. Most adults tend to pursue self‐directed treatment, including diet and exercise strategies [1]. However, with the introduction of new and highly effective antiobesity medications (AOMs) that lead to improved treatment effects for a broader range of people, many individuals are becoming more interested in pursuing pharmacological treatment of obesity. A recent survey by the Kaiser Family Foundation found that 45% of people would be interested in taking AOMs, including 59% of those currently trying to lose weight, generating significant demand [2].

The newest AOM treatments are glucagon‐like peptide‐1 receptor agonist (GLP‐1‐RA)‐based drugs, which produce weight loss averaging 15% to 21% in phase 3 clinical trials along with significant improvements in cardiometabolic health [3, 4, 5]. The most common side effects include nausea, vomiting, diarrhea, constipation, and gastroesophageal reflux [6, 7]. Concurrent with the newest obesity GLP‐1‐RAs, there has been broad adoption of telehealth as a model for care delivery, especially following the COVID‐19 pandemic [8]. Patients and health care professionals had to quickly adapt to the predominant use of telehealth to meet health care needs in many traditional outpatient settings. The convergence of highly effective AOMs, growing patient demand for treatment, and a broader embrace of telehealth has led to an increase in telehealth solutions for obesity treatment, particularly AOMs. There has been limited evaluation of the effectiveness of these new treatment models in real‐world settings despite their rapid appearance and uptake.

This analysis describes the observed effects of a telehealth medical obesity‐treatment program on weight‐loss outcomes in a large cohort of patients. Our primary objective was to describe changes in weight in members of a telehealth medical weight‐management program. Furthermore, we wanted to understand patterns of real‐world medication usage and side effects over the course of treatment.

METHODS

Study design

This study was a retrospective case series of data sourced from a telehealth obesity medicine provider (WW Clinic) encompassing individuals who enrolled between January 2022 and July 2023. This study was considered exempt by the Institutional Review Board at the University of Florida (NH00021333) because deidentified health care records were used. The objective of the study was to describe real‐world weight‐loss outcomes and side effects prevalence. We also sought to identify real‐world medication usage over time.

Treatment program

Sequence, a multidisciplinary telehealth medical weight‐management program that started in 2022, was acquired by WW International, Inc., in 2023 and is now WeightWatchers (WW) Clinic. A flowchart detailing the patient enrollment and treatment flow is presented in Figure S1. Briefly, prospective WW Clinic members begin by taking a 5‐min online quiz to evaluate whether they medically qualify for the program. The requirements for medical qualification for the program aligned with the Food and Drug Administration (FDA) guidelines for AOMs of having BMI ≥ 30 kg/m² or BMI ≥ 27 kg/m² with a related comorbidity such as prediabetes, hyperlipidemia, obstructive sleep apnea, or hypertension. If deemed a potential candidate for treatment, patients provide weight verification and meet virtually with a board‐certified clinician who has undergone screening and training, including a screener for obesity bias and stigma, education in the pathophysiology and pharmacology of obesity, electronic medical record training, and biweekly clinical case reviews and policy update meetings. The clinician then assesses whether the patient is medically appropriate for AOMs and, if so, for which ones. Providers engage in patient‐centered care and decision‐making, and medications are prescribed based on a variety of factors, including medical history, insurance coverage, patient needs and goals, and recommended starting dosage and titration maximum for GLP‐1 medications. Throughout the program, patients' care is supported by care team coordinators, and patients have access to registered dietitians and fitness specialists to develop personalized nutrition and fitness plans. Patients interact with a clinician monthly (but more as needed) for regular check‐ins, including a side effects checklist, to adjust treatment plans. Patients also have access to the program's app, enabling real‐time tracking of progress, nutrition, and physical activity; instant messaging with their care team for assistance; and prescription refill requests. The program cost is $99/month, paid directly by the patient, and includes the clinical care; generic, nonschedule IV AOMs (e.g., bupropion/naltrexone, metformin); registered dietitian and fitness specialist visits; care coordination; assistance with prior authorization; and location of medications when supply is constrained. When prescribed, GLP‐1 medications are covered by insurance or directly by patients, with monthly out‐of‐pocket costs of up to $1350 for Wegovy (semaglutide) and $1060 for Zepbound (tirzepatide).

Study sample

Our analytic sample selection process is depicted in Figure 1. Initially, we included 442,686 prospective patients who completed the initial assessment questionnaire. A little more than one quarter (29%) were deemed medically ineligible for AOM treatment based on a variety of criteria, including having BMI < 27 kg/m²; having no comorbidities within the BMI range of 27 to 29.9 kg/m²; being pregnant or breastfeeding; having a history of bulimia, anorexia, or type 1 diabetes; and residing outside of the United States, where WW Clinic cannot provide services. Subsequently, a total of 315,765 patients met the initial necessary medical eligibility criteria for a visit with a health care provider. Among those who were medically eligible, we excluded individuals who never made an appointment or met with a clinician, resulting in 53,590 WW Clinic members who met with a clinician, received a treatment plan, received at least 1 month of AOM treatment, and requested at least one prescription refill. Of those who initiated treatment, 6459 (76.9%) maintained their membership for at least 12 months (out of n = 8394 whose enrollment timeline allowed for 12‐month data collection), and 6089 had complete 12‐month data. The remaining 1935 who initiated treatment but canceled their program membership before the 12‐month period concluded (i.e., the premature discontinuation group) were also analyzed to provide real‐world insights for all patients. Our analyses focus on those who initiated treatment (i.e., the initiation cohort) and those with complete 12‐month data (i.e., the 12‐month data cohort).

FIGURE 1.

Study sample selection flowchart.

Data collection

Data used in the retrospective analysis included weight at the initial consultation (baseline; 0 months) and at 3, 6, 9, and 12 months; AOM‐related side effects, assessed monthly; and the first and last AOMs used.

Baseline weight and height were captured through self‐report via the initial online assessment, with weight verification provided through pictures on digital scales for eligibility starting in April 2023, when WW International acquired WW Clinic (formerly Sequence). Subsequent weight measurements were self‐reported by members through the WW Clinic app each time they refilled their prescription (generally once per month). Side effects prevalence was also self‐reported by members through the WW Clinic app as a requirement for prescription refill.

The first and last AOMs used were also collected via the WW Clinic app, which is where members request their monthly medication refills. The first AOM was defined as the first medication to be prescribed to the member, and the last AOM was defined as any active prescription or refill at 12 months or the last follow‐up visit. The last AOM was captured based on the last three using a 15‐day window (including the same day the medication was prescribed) among the last three prescriptions. In some cases, if the prescribed AOM treatment differed from the one that was filled, the last AOM was described as a combination of the two medications. For example, if a member was prescribed naltrexone and bupropion and filled a prescription for metformin within the 15‐day time window, the last AOM was described as “naltrexone + bupropion + metformin.”

Measures

The study endpoints were weight change (kilograms and percentage of initial body weight lost) at 3, 6, 9, and 12 months after treatment initiation. Side effects were categorized into the following six common symptoms: loss of appetite; constipation; diarrhea; injection‐related symptoms (e.g., pain, swelling, irritation); nausea; heartburn/indigestion, as well as other symptoms. For both the initiation and 12‐month data cohorts, we report the proportion of patients who noted any side effects during treatment. To examine the persistence of side effects, we also report the prevalence of side effects at each time point for the 12‐month data cohort.

Analysis

Descriptive statistics were used to summarize the baseline demographics and clinical characteristics of the study sample. The change in weight from baseline was calculated for the initiation cohort (n = 53,590) and the 12‐month data cohort (n = 6089).

For the 12‐month data cohort, study outcomes incorporated all patients who initiated the treatment plan and provided 12‐month data and for whom a 12‐month treatment duration was possible based on their time of enrollment. We used complete case analysis to deal with missing data on weight outcomes in the interim periods, which were minimal (i.e., less than 5% for each study period time point). Data analysis was conducted using SAS version 9.4 (SAS Institute Inc., Cary, North Carolina).

RESULTS

Individuals who inquired about WW Clinic were, on average, 43.6 years old, and over 90% were female (Table 1), with a mean BMI of 35.5 kg/m², mean weight of 97.3 kg, and average history of 2.6 previous weight‐loss attempts. Over one‐third of patients reported using AOMs previously. Hypertension and prediabetes were the most reported obesity‐related complications. As inquirers progressed through evaluation to receiving a treatment plan and being followed for at least 12 months, the mean age and proportion who were female remained consistent. The average weight in the group that initiated treatment was 4.8 kg higher than the initial screeners. Those who initiated treatment were more likely to have tried AOMs or bariatric surgery previously than those in the initial screening cohort. The mean (SD) length of time in the program for the initiation cohort was 5.3 (4.3) months; for the 12‐month data cohort, the length of time in the program was 12.6 (1.4) months.

TABLE 1.

Study sample characteristics.

	Initially screened	Received treatment plan	Initiated plan and refilled	With 3‐mo follow‐up complete	With 12‐mo follow‐up complete
Total no.	442,686	69,850	53,590	37,565	6089
Age, mean (SD), y	43.6 (11.8)	42.5 (10.3)	42.0 (9.9)	42.4 (9.9)	43.4 (9.3)
Sex, %
Female	92.40	88.40	88.63	88.37	91.11
Male	7.50	11.54	11.36	11.2	8.89
Unknown/not disclosed	0.10	0.06	0.01	0.01
Self‐reported weight, mean (SD), lb	214.6 (49.2)	223.4 (45.8)	225.0 (45.8)	225.4 (45.9)	228.0 (45.9)
Self‐reported BMI, mean (SD), kg/m2	35.5 (7.3)	36.6 (6.4)	36.9 (6.5)	36.9 (6.5)	37.4 (6.6)
No. of previous diets tried, mean (SD)	2.6 (1.2)	2.9 (1.2)	2.9 (1.2)	2.9 (1.2)	2.9 (1.2)
Type of weight loss tried in the past, %
Dieting	98.03	98.83	98.92	99.03	99.12
Exercise plan	86.98	90.15	90.48	90.55	90.33
Coaching	42.25	49.71	49.96	50.34	54.23
Medications	36.95	41.68	43.14	43.17	47.57
Bariatric surgery	1.33	7.09	7.59	8.69	6.20
Other	7.64	8.26	8.46	7.59	9.00
Previous diagnosis, %
Type 2 diabetes	3.81	2.95	2.99	3.17	2.74
Obstructive sleep apnea	10.96	11.63	11.13	11.25	10.59
Low HDL cholesterol	4.39	5.71	5.45	5.66	5.00
High triglycerides	14.18	16.63	15.98	16.53	14.53
Prediabetes	15.28	18.21	18.02	17.84	14.95
Hypertension	23.41	24.76	23.89	24.29	20.29
Heart disease	1.32	0.97	0.91	0.90	0.78
Polycystic ovary syndrome	11.21	12.96	13.42	13.12	13.65
Osteoarthritis	5.47	4.12	3.69	3.74	4.30
Nonalcoholic fatty liver disease	4.46	4.64	4.41	4.22	4.70
Urinary incontinence	0.93	1.01	1.28	1.48	3.21
Gastroesophageal reflux disease	3.50	4.21	5.35	6.04	12.40
None	46.70	42.02	42.77	42.39	43.49

The continuous and categorical changes in weight over time for the initiation cohort and the 12‐month data cohort are shown in Figure 2 and Figure S2, respectively. The sample size of patients who had an enrollment period sufficient for the time span evaluated out of the total number of patients whose time from enrollment was at least 3, 6, 9, and 12 months (including those who prematurely discontinued) was n = 39,907/51,247 at 3 months, n = 25,515/40,203 at 6 months, n = 15,472/26,794 at 9 months, and n = 6459/8394 at 12 months. This resulted in retention rates of 78% at 3 months, 63% at 6 months, 58% at 9 months, and 77% at 12 months. Of those, weight data were available for n = 37,565/39,907 (94%) at 3 months, n = 24,140/25,515 (94.6%) at 6 months, n = 15,169/15,472 (98%) at 9 months, and n = 6089/6459 (94.3%) at 12 months. For the initiation cohort, weight loss at 3 months was 8.9%, 14.1% at 6 months, 17.7% at 9 months, and 19.4% at 12 months.

FIGURE 2.

Weight change for (A) patients with treatment initiation and (B) those with complete 12‐month data. In panel A, “No. of participants in program” refers to the number of individuals who had an enrollment period sufficient for the time span evaluated (the numerator) out of the total number of patients whose time from enrollment was at least 3, 6, 9, and 12 months, including those who prematurely discontinued the program (the denominator). “No. of participants analyzed” refers to those who had an enrollment period sufficient for the time span evaluated and no missing data for the weight outcome at each data analysis time point (the numerator). In panel B, “No. of participants completed 12‐month follow‐up” refers to those who had an enrollment of at least 12 months and weight‐outcome data at 12 months (the numerator) out of the total number of patients whose time from enrollment was at least 12 months, including those who prematurely discontinued the program (the denominator). “No. of participants analyzed” refers to those who completed 12‐month follow‐up and had complete weight data at the given time point and thus were included in the analysis. [Color figure can be viewed at wileyonlinelibrary.com]

Table S1 includes sample characteristics of those who initiated treatment and refilled medication (n = 53,590), those with complete 12‐month data (n = 6089), and those who had sufficient lead time to be included in the 12‐month data cohort but canceled their subscription at some point prior to 12 months and were thereby included in the premature discontinuation group (n = 1935). No clinically significant differences were observed among the three groups.

Figure 3 depicts the prevalence of side effects over time by initial prescribed medication. In the early months of treatment, the prevalence of side effects was generally higher, and those in the 12‐month data cohort with reported side effects were less likely to be missing 12‐month outcome data (p < 0.0001). Constipation was reported by 5% to 25% of patients in the first month of treatment with all medications, with patients using Rybelsus (semaglutide) reporting the most constipation in the first month and patients using Wegovy reporting the least. This prevalence decreases over time, such that, by month 5, fewer than 10% of patients were reporting any constipation. Diarrhea and nausea followed a similar pattern, with decreasing prevalence over time. The prevalence of nausea was less than 10% for most medications by month 8, except for Victoza (liraglutide).

FIGURE 3.

Monthly reports of side effects by type of medication among participants with complete 12‐month data since treatment initiation. [Color figure can be viewed at wileyonlinelibrary.com]

Gastrointestinal side effects were the major share of side effects reported at any time during treatment across all patients. Nausea was the most frequent gastrointestinal side effect, being reported by 29.2% of those who initiated treatment and 46.2% of those in the 12‐month data cohort. Constipation was the second most common side effect, reported by 18.5% of the initiation cohort and 30.7% of the 12‐month data cohort. Additional reported gastrointestinal‐related side effects included diarrhea and heartburn/indigestion, occurring in 14.7% and 13.6% of patients in the 12‐month data cohort, respectively. The pattern was similar in the initiation cohort, with 8.5% of people reporting diarrhea and 7.3% reporting heartburn/indigestion. Loss of appetite and injection‐related events were reported by less than 5% of patients in either cohort.

For some patients, their treatment strategy varied over time. We examined the frequency of continuing with the original prescription or moving to a different treatment option (Table S2) and weight changes at 12 months by first and last AOM combination (Table 2). Of those in the 12‐month data cohort (n = 6089), 9 (0.001%) patients began with naltrexone/bupropion; however, 204 (3.4%) patients were treated with naltrexone/bupropion by the end of 12 months. Only 4 (0.001%) patients began and ended the 12‐month period with naltrexone/bupropion. Of the 731 (12.0%) patients who were initially prescribed metformin, only 32 (4.4%) remained on this AOM treatment at 12 months. Those who were initiated on metformin had mean weight loss ranging from 9.7% to 20.3%, with the highest weight loss for those who transitioned to a GLP‐1–based treatment. Mounjaro (tirzepatide) was the most prescribed initial and final medication, with 3118 (51.2%) patients treated on this medication at initiation and at 12 months; the average 12‐month weight loss was 21.2% for these patients. Wegovy and Ozempic (semaglutide) ranked as the second and third most frequently prescribed final medications, associated with body weight loss of 15.3% and 13.8%, respectively. There were 763 (12.5%) patients who were exclusively on Wegovy at the end of 12 months. Patients who switched from Mounjaro tended to be prescribed either Wegovy or Ozempic more often. For patients who were treated with Saxenda (liraglutide) at initiation and at 12 months, the average weight loss was 12.0%.

TABLE 2.

Weight changes at 12 months by first and last AOM combination.

Initial medication	Final medication
	Naltrexone/bupropion		Metformin		Mounjaro		Ozempic		Rybelsus		Saxenda		Trulicity		Victoza		Wegovy
	No.	Weight change	No.	Weight change	No.	Weight change	No.	Weight change	No.	Weight change	No.	Weight change	No.	Weight change	No.	Weight change	No.	Weight change
Naltrexone/bupropion	4	−5.8%	0		3	−17.0%	1	−24.8%	0		0		0		0		2	−7.9%
Metformin	33	−9.7%	32	−12.5%	343	−20.3%	174	−14.4%	3	−11.1%	48	−11.8%	6	−18.7%	1	−18.3%	91	−17.1%
Mounjaro	161	−19.5%	94	−18.9%	3118	−21.2%	198	−17.5%	18	−17.6%	159	−16.8%	10	−15.4%	0		588	−18.6%
Ozempic	3	−16.1%	5	−12.3%	84	−18.2%	56	−13.8%	4	−25.7%	3	−10.1%	2	−8.5%	0		14	−18.6%
Rybelsus	2	−8.5%	0		3	−21.9%	0		0		3	−12.0%	7	−8.1%	0		0
Saxenda	1	−14.8%	1	−7.3%	57	−19.6%	16	−13.7%	0		22	−12.0%	3	−7.9%	1	−30.0%	44	−10.3%
Trulicity	3	−20.9%	0		29	−20.2%	4	−21.2%	0		2	−28.9%	0		0		7	−16.6%
Victoza	1	−22.0%	3	−12.7%	32	−21.1%	0		0		2	−12.3%	0		0		8	−21.1%
Wegovy	0		1	−24.7%	27	−18.0%	4	−24.1%	1	−13.0%	1	−10.3%	0		0		9	−15.3%

Abbreviation: AOM, antiobesity medication.

DISCUSSION

This analysis of medical obesity treatment delivered via telehealth revealed significant insights into who used the service, patterns of treatment, treatment effectiveness, and side effects. Despite high interest in obesity treatment, only 17% of medically eligible individuals (53,590 out of 315,765) initiated treatment. Most patients were middle‐aged female individuals, with over one‐half reporting obesity‐related complications or health concerns. Observed treatment outcomes were consistent with evidence from recent phase 3 clinical trials, with patients experiencing an average weight loss of nearly 10% within 3 months and 19.4% at the 12‐month mark across various medications. Side effects, which were predominantly gastrointestinal, aligned with expectations for the medication classes used and were most prevalent at the beginning of treatment, decreasing over time. GLP‐1‐RAs were the most prescribed monotherapy, with Mounjaro being associated with an average weight loss of 21.2% at 12 months. Metformin and naltrexone/bupropion were the primary non‐GLP‐1–based options, used by about 5% of the patients at the end of 12 months.

In comparing these data with the SURMOUNT‐1 (tirzepatide), STEP‐1 (semaglutide 2.4 mg), and SCALE (liraglutide 3.0 mg) trials, there are notable differences and similarities in study populations and outcomes [3, 5, 9]. The telehealth program population differs slightly from all three clinical trials, with this real‐world analysis having more women initiating treatment (88.6%) than in clinical trials with predominantly female (67.5%–78.7%) and middle‐aged demographics. The clinical trial populations had more obesity‐related health conditions, e.g., ~60% of the SCALE trial population had prediabetes (compared with 18% who received treatment in the present study), and two‐thirds of the SURMOUNT‐1 and 75% of STEP‐1 populations had an obesity‐related health condition (compared with 58% in the present study) [3, 5, 9]. A higher prevalence of obesity‐related conditions may reflect not only a higher percentage of men in the clinical trials but also a higher average BMI, in that each trial had a mean BMI of ~38 kg/m², which was 2.5 units higher than in the current sample. Additionally, it could be that higher‐acuity patients already have specialized care such as that provided from an endocrinologist or cardiologist, who feel comfortable prescribing these medications, and those who seek telehealth obesity treatment are of lower acuity. The average weight losses for each AOM treatment in the study population were generally consistent with or better than those reported in the clinical trials. Notably, liraglutide 3.0 mg was associated with ~12% weight loss in the current sample compared with the 8% weight loss in SCALE; however, it should be noted that the sample size for those who initiated and ended treatment with liraglutide 3.0 mg was small (n = 22) [9]. Side effects in the current sample were comparable with those in the clinical trials, with gastrointestinal‐related complaints predominant in a similar pattern of frequency and appearance.

The achievement of these outcomes using a telehealth model suggests that obesity treatment can be successfully delivered via this approach. Prior evidence of remotely delivered behavioral interventions for obesity has typically been associated with similar outcomes to those seen with in‐person delivery [10, 11]. There has been scant research on remotely delivered treatment strategies that feature AOM prescription in addition to support for lifestyle change management and none, to our knowledge, with recently approved, highly effective GLP‐1‐RAs. One short‐term randomized controlled trial demonstrated that prescribing phentermine via virtual visits was as effective as using in‐person encounters [12]. Following an in‐person initial evaluation with a medical provider, patients were prescribed 18.75 mg of phentermine daily, which was increased to 37.5 mg if tolerated after 2 weeks. After monthly follow‐up for 12 weeks using video visits or in‐person visits, the weight loss was 7.7% of initial body weight for in‐person compared with 6.5% for virtual treatment. The lack of difference suggested that a virtually based treatment strategy focused on prescribing AOMs could be comparable with in‐person visits. The current observational study aligns with the prior body of evidence in which treatment effects were similar to those observed in in‐person settings and does so with a large sample using the latest AOMs in a real‐world setting. Additional research is needed to understand how telehealth modalities can further extend the reach and impact of obesity treatment, especially as patient and provider acceptance of this form of health care delivery continues to increase [13].

As telehealth use expands, there is still much to learn about what is defined as standard of care for medical obesity treatment that is provided entirely remotely. There are several advantages afforded by telehealth, including convenience and time savings, but there are limitations such as the lack of clinical measures if remote monitoring is unavailable or technological challenges that may negatively impact care delivery [8]. The results of this analysis suggest that expected treatment effects can be achieved across a self‐selected population of interested patients as a starting point; future efforts to define minimum standards for how the care should be delivered and how it can be integrated into other aspects of health care for the patient can further advance the field.

This study has several strengths. It is the first study, to our knowledge, of a widely available telehealth approach for the medical treatment of obesity. Such data are the first step to evaluate this rapidly growing modality of obesity treatment. This study provides real‐world evidence of the impact of treating obesity with an array of AOMs, including the latest GLP‐1‐RAs. These data suggest that the effects of these medications generalize beyond in‐person and clinical trial settings. Another strength is the large sample size of over 50,000 people who started treatment and the 77% retention of the 8394 patients whose enrollment timeline allowed for 12‐month data collection. Finally, it evaluates an approach that is widely available across the United States and not limited to any geographic region, increasing its generalizability.

This study also has several limitations. It was a retrospective, single‐arm descriptive study that used a convenience sample of self‐selected patients interested in pursuing this treatment strategy for obesity management. Although the study sample was very similar to samples from some recent, large phase 3 clinical trials, the small percentage of men and the lack of race and ethnicity data limit generalization. As a retrospective analysis, we can only draw associations that would support future hypothesis testing. Additionally, although we included all patients who initiated the program in our analysis, those who started their treatment plan on or before July 15, 2022, allowing them to complete 12 months by the study's conclusion (n = 6459), may differ systematically from those who had enough time to complete 12 months but canceled program membership within the 12‐month period (n = 1935). This could lead to an overestimation of the program's effectiveness if those who continued were more likely to be a responder to treatment and/or had fewer side effects. Nonetheless, retention in the 12‐month program was high, with 76.9% of members who started their membership 12 or more months before the study remaining in the program at 12 months. Another limitation is that nearly one‐half of the patients switched medications at least once during the 12‐month period; therefore, outcomes for patients who switched cannot be cleanly attributed to a single AOM. To address this, weight change was analyzed based on the first and last AOMs used. Finally, because of the nature of the virtual intervention, all treatment outcomes are self‐reported, although self‐reported weight has been shown to have a high correlation with measured weight in several remotely delivered weight‐loss interventions [14, 15, 16].

In conclusion, to our knowledge, this is the first description of weight changes experienced by members of a large telehealth medical obesity‐treatment strategy with results reported in over 6000 patients at 12 months. This real‐world evidence analysis suggests that patients were able to achieve weight losses that were comparable with those seen in recent phase 3 clinical trials. There were no new safety concerns identified, and the side effects profiles were consistent with the categories of medications used. A range of AOM treatments were used, but GLP‐1‐RAs were the dominant category of AOMs prescribed. This approach for obesity treatment holds promise for extending access to care in a way that is scalable and efficient. Additional research is needed to understand how this care delivery model compares with in‐person care models and how to ensure quality and establish standards of care for telehealth obesity treatment.

AUTHOR CONTRIBUTIONS

Jamy D. Ard, Gary D. Foster, Adam Metcalf, Spencer Nadolsky, and Michelle I. Cardel conceived the study. Adam Metcalf pulled the data. Young‐Rock Hong conducted the data analysis. All authors were involved in results interpretation. Jamy D. Ard and Michelle I. Cardel drafted the first draft of the manuscript. All authors were involved in writing the manuscript and had final approval of the submitted manuscript. Jamy D. Ard and Young‐Rock Hong had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

FUNDING INFORMATION

WW International, Inc., provided funding for Young‐Rock Hong as a consultant on this study.

CONFLICT OF INTEREST STATEMENT

Jamy D. Ard reports research support from Nestlé Health Science, Eli Lilly and Company, Epitomee Medical Ltd, UnitedHealth Group Inc., Novo Nordisk A/S, KVK Tech, and WW International, Inc.; he serves as a consultant for Regeneron Pharmaceuticals, Inc., Brightseed, Boehringer Ingelheim, Intuitive Health, Novo Nordisk A/S, Eli Lilly and Company, and WW International. He did not receive payment for any work related to this study or manuscript. Spencer Nadolsky, Gary D. Foster, Michelle I. Cardel, and Adam Medcalf are employees and shareholders at WW International. Young‐Rock Hong served as a consultant for WW International on this manuscript. He reported receiving grants from the American Gastroenterological Association Health Disparities Award and the American Society of Clinical Oncology (ASCO) and Pfizer's Conquer Cancer collaboration.

Supporting information

Figure S1. WW Clinic Patient Flowchart.

Figure S2. Categorical Weight Change for Participants with Treatment Initiation (A) and Those with Complete 12‐Month Data (B).

Table S1. Characteristics of Study Samples and Those Eligible for Enrollment for 12‐months but Did not Remain in the Program.

Table S2. Antiobesity medication switch rates.

Ard JD, Hong Y‐R, Foster GD, Medcalf A, Nadolsky S, Cardel MI. Twelve‐month analysis of real‐world evidence from a telehealth obesity‐treatment provider using antiobesity medications. Obesity (Silver Spring). 2024;32(12):2246‐2254. doi: 10.1002/oby.24169

DATA AVAILABILITY STATEMENT

Deidentified data will be made available upon request after review and approval of usage.