Abstract
This cohort study examines the association of antiobesity medication use and alcohol use among participants enrolled in a weigh loss program.
Introduction
Antiobesity medications (AOMs), including glucagon-like peptide-1 receptor agonists (GLP-1 RAs), are effective for achieving weight loss.1 Additionally, GLP-1 RA use was associated with lower incidence and recurrence of alcohol use disorder.2 Exploring a variety of AOMs, as well as changes in amount of alcohol use, could offer comparative insight into the potential impact of various AOMs. The purpose of this study was to examine changes in alcohol use among individuals enrolled in a telehealth weight management program after initiation of an AOM.
Methods
This cohort study was approved by the Henry Ford Health institutional review board. Informed consent was waived, as information was collected as a part of clinical care and all data were deidentified. This study follows the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline for cohort studies. Individuals eligible for this study were enrolled in the WeightWatchers (WW) Clinic telehealth medical weight management program.3 Individuals were included if they initiated an AOM between January 2022 and August 2023 and refilled the same AOM between October 2023 and November 2023. AOMs included were categorized as metformin, bupropion and naltrexone, first-generation GLP-1 RA (ie, liraglutide and dulaglutide), or second-generation GLP-1 RA (ie, tirzepatide and semaglutide). Individuals were excluded if they were using an AOM before enrollment at the WW Clinic, as the purpose was to examine changes in alcohol use after initiation of an AOM. Individuals with a history of bariatric surgery were also excluded, given different risk profiling for an alcohol use disorder. Prior to AOM initiation, individuals completed a baseline survey, which included self-reported age, sex at birth, race and ethnicity, height, and weight. Race and ethnicity were self-reported as Asian, Black or African American, White, other (eg, American Indian or Alaska Native, Native Hawaiian or Other Pacific Islander, multiracial), and unknown. Race and ethnicity were assessed because race and ethnicity have had associations with weight and alcohol use. Height and weight were used to calculated body mass index (BMI; calculated as weight in kilograms divided by height in meters squared). Participants also reported their weekly alcohol use prior to AOM initiation and again at the time of refill. Information regarding categorization of alcohol use is provided in the eMethods in Supplement 1. Only 113 of 14 166 individuals (0.8%) did not complete the refill survey. Multivariate logistic regression was conducted to compare participants who decreased alcohol use with those who did not decrease use after initiation of an AOM, with inclusion of covariates, given associations with weight and alcohol use. P values were 2-sided, and statistical significance was set at P < .05. Analyses were conducted with R software version 4.4.0 (R Project for Statistical Computing) from January to May 2024.
Results
This study included 14 053 participants (12 081 [86.0%] female; mean [SD] age, 43.17 [10.13] years; mean [SD] BMI, of 35.97 [6.28]) (Table 1). Most participants (12 116 [86.2%]) were prescribed a second-generation GLP-1 RA. Approximately half reported drinking any alcohol at baseline (7491 participants [53.3%]). Across all participants, 3395 (24.2%) had a decrease in alcohol use. Among 7491 participants with alcohol use at baseline, 3395 (45.3%) reported decreasing a category of alcohol use, 3923 (52.4%) reported no change, and 173 (2.3%) reported an increase. Among participants who reported alcohol use at baseline, those with a higher class of obesity and those with higher levels of drinking were more likely to reduce their use (Table 2). Individuals receiving bupropion and naltrexone had a greater likelihood of reporting decreases in alcohol use compared with metformin (Table 2). However, this was no longer significant after controlling for weight loss (adjusted odds ratio, 1.33; 95% CI, 0.95-1.86; P = .10).
Table 1. Baseline Participant Characteristics .
| Characteristic | Participants, No. (%) (N = 14 053) |
|---|---|
| Age, y | |
| Mean (SD) | 43.17 (10.13) |
| 18-29 | 1209 (8.6) |
| 30-44 | 6702 (47.7) |
| 45-54 | 4076 (29.0) |
| ≥55 | 2066 (14.7) |
| Sex | |
| Female | 12 081 (86.0) |
| Male | 1972 (14.0) |
| Race and ethnicity | |
| Asian | 274 (1.9) |
| Black or African American | 712 (5.1) |
| White | 8427 (60.0) |
| Othera | 402 (2.9) |
| Missing | 4238 (30.2) |
| BMI, mean (SD) | 35.97 (6.28) |
| Obesity status at baselineb | |
| Overweight | 1639 (11.7) |
| Obesity class I | 5803 (41.3) |
| Obesity class II | 3659 (26.0) |
| Obesity class III | 2952 (21.0) |
| Weekly alcohol usec | |
| Category 0 | 6562 (46.7) |
| Category 1 | 5948 (42.3) |
| Category 2 | 1216 (8.7) |
| Category 3 | 327 (2.3) |
| AOM treatment | |
| Metformin | 560 (4.0) |
| Bupropion/naltrexone | 675 (4.8) |
| First-generation GLP-1 RA | 702 (5.0) |
| Second-generation GLP-1 RA | 12 116 (86.2) |
| Duration from AOM initiation to follow-up survey, mean (SD), d | 224.60 (123.04) |
| Total weight loss from AOM initiation to follow-up survey, mean (SD), % | 12.68 (8.23) |
Abbreviations: AOM, antiobesity medication; BMI, body mass index (calculated as weight in kilograms divided by height in meters squared); GLP-1 RA, glucagon-like peptide-1 receptor agonist.
Includes American Indian or Alaska Native, Native Hawaiian or Other Pacific Islander, or multiracial.
Overweight was defined as BMI of 25 to less than 30; class I obesity, BMI of 30 to less than 35; class II obesity, BMI of 35 to less than 40; class III obesity: BMI of 40 or greater.
Category 0, indicates none; category 1, 1 to 3 drinks for females and 1 to 6 drinks for males; category 2, 4 to 6 drinks for females and 7 to 14 drinks for males; category 3, at least 7 drinks for females and at least 15 for males.
Table 2. Multivariate Logistic Regression to Compare Individuals Who Did and Did Not Decrease Alcohol Use After Initiation of an AOM .
| Characteristic | aOR (95% CI) (n = 7491) | P value |
|---|---|---|
| Age, y | ||
| 18-29 | 1 [Reference] | NA |
| 30-44 | 1.08 (0.90-1.30) | .42 |
| 45-54 | 1.02 (0.84-1.25) | .82 |
| ≥55 | 0.96 (0.77-1.19) | .70 |
| Sex | ||
| Female | 1 [Reference] | NA |
| Male | 0.74 (0.64-0.85) | <.001 |
| Race and ethnicity | ||
| Asian | 1.19 (0.79-1.76) | .40 |
| Black or African American | 1.14 (0.90-1.43) | .29 |
| White | 1 [Reference] | NA |
| Othera | 1.22 (0.89-1.68) | .21 |
| Missing | 1.10 (0.92-1.33) | .30 |
| Obesity status at baselineb | ||
| Overweight | 1 [Reference] | NA |
| Obesity class I | 1.26 (1.07-1.48) | .005 |
| Obesity class II | 1.49 (1.26-1.77) | <.001 |
| Obesity class III | 1.63 (1.36-1.96) | <.001 |
| Duration of follow-up, mean (SD), d | 1.00 (1.00-1.00) | <.001 |
| Weekly alcohol use at baselinec | ||
| Category 1 | 1 [Reference] | NA |
| Category 2 | 5.97 (5.17-6.91) | <.001 |
| Category 3 | 19.18 (13.25-28.86) | <.001 |
| AOM treatment | ||
| Metformin | 1 [Reference] | NA |
| Bupropion/naltrexone | 1.42 (1.01-1.99) | .04d |
| First-generation GLP-1 RA | 1.22 (0.88-1.70) | .23 |
| Second-generation GLP-1 RA | 1.19 (0.91-1.55) | .20 |
Abbreviations: AOM, antiobesity medication; aOR, adjusted odds ratio; GLP-1 RA, glucagon-like peptide-1 receptor agonist; NA, not applicable.
Includes American Indian or Alaska Native, Native Hawaiian or Other Pacific Islander, or multiracial.
Overweight was defined as body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of 25 to less than 30; class I obesity, BMI of 30 to less than 35; class II obesity, BMI of 35 to less than 40; class III obesity: BMI of 40 or greater.
Category 0, indicates none; category 1, 1 to 3 drinks for females and 1 to 6 drinks for males; category 2, 4 to 6 drinks for females and 7 to 14 drinks for males; category 3, at least 7 drinks for females and at least 15 for males.
This was no longer significant when accounting for weight loss.
Discussion
This cohort study among individuals participating in a weight loss program found that nearly half of those consuming alcohol at baseline decreased their alcohol use after AOM initiation. There may be properties of AOMs that lead to reduced use. For example, naltrexone decreases cravings for alcohol4 and GLP-1 RAs may attenuate the rewarding effects of alcohol, similar to food.5 Unexpectedly, participants using metformin also reported a decrease in alcohol use. This may have occurred because of engagement in a weight management program, as behavioral strategies may suggest limiting alcohol consumption, given its caloric content and disinhibitory effects on cognitive restraint.6 Enrolled individuals may have greater motivation for health behavior change than non–treatment seeking individuals. Future research would benefit from a randomized trial comparing AOMs with a placebo-controlled or nonpharmacological weight management group.
eMethods.
Data Sharing Statement
References
- 1.Ard J, Fitch A, Fruh S, Herman L. Weight loss and maintenance related to the mechanism of action of glucagon-like peptide 1 receptor agonists. Adv Ther. 2021;38(6):2821-2839. doi: 10.1007/s12325-021-01710-0 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Wang W, Volkow ND, Berger NA, Davis PB, Kaelber DC, Xu R. Associations of semaglutide with incidence and recurrence of alcohol use disorder in real-world population. Nat Commun. 2024;15(1):4548. doi: 10.1038/s41467-024-48780-6 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Ard J, Hong YR, Foster G, Medcalf A, Nadolsky S, Cardel M. Twelve-month analysis of real-world evidence from a commercial telehealth obesity treatment provider. Research Square. Preprint posted online March 5, 2024. doi: 10.21203/rs.3.rs-3959336/v1 [DOI] [PMC free article] [PubMed]
- 4.Maisel NC, Blodgett JC, Wilbourne PL, Humphreys K, Finney JW. Meta-analysis of naltrexone and acamprosate for treating alcohol use disorders: when are these medications most helpful? Addiction. 2013;108(2):275-293. doi: 10.1111/j.1360-0443.2012.04054.x [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Klausen MK, Thomsen M, Wortwein G, Fink-Jensen A. The role of glucagon-like peptide 1 (GLP-1) in addictive disorders. Br J Pharmacol. 2022;179(4):625-641. doi: 10.1111/bph.15677 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Kase CA, Piers AD, Schaumberg K, Forman EM, Butryn ML. The relationship of alcohol use to weight loss in the context of behavioral weight loss treatment. Appetite. 2016;99:105-111. doi: 10.1016/j.appet.2016.01.014 [DOI] [PMC free article] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
eMethods.
Data Sharing Statement