Current status of anti-obesity medications and performance, an EHR based survey.
4 affiliations
- 1Department of Quantitative and Systems Health Sciences, Dell Medical School, University of Texas at Austin, 1501 Red River St, Austin, TX, 78712, USA.
- 2Department of Health Data Science and AI, McWilliams School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, TX, USA.
- 3Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA.
- 4Department of Quantitative and Systems Health Sciences, Dell Medical School, University of Texas at Austin, 1501 Red River St, Austin, TX, 78712, USA. [email protected].
Abstract
Background
While randomized clinical trials (RCTs) establish the efficacy of anti-obesity medications (AOMs), their real-world effectiveness, inter-individual variability, and weight regain post discontinuation remain poorly characterized across diverse, large scale populations.Methods
Electronic health records with pharmacy dispensation of obesity or overweight individuals were retrieved from local UT-Physician and nationwide EPIC COSMOS databases. AOMs were analyzed for short to long-term effectiveness on obesity relevant metrics.Results
From the two cohorts, 71,318 (11·7%) and 1 M (27·9%) individuals documented AOM exposures, respectively, with about 70% individuals experiencing more than one treatment session. Tirzepatide and Semaglutide outperformed other AOMs and were associated with up to 9·6[IQR:11]% and 6·2[IQR:11]% weight loss, respectively, and both improved blood pressure, HbA1c, and lipid profile. The median exposure durations were approximately 4·6 months for the two GLP-1/GIP AOMs, far short of the 72-week duration typically required for peak therapeutic benefit in RCTs. All AOMs showed substantial inter-individual variability in responses, regardless of exposure length. Substantial differences were found between RCT and real-world performance. For example, while Tirzepatide led both cohorts, nearly 50% and 25% of individuals didn't achieve the 10% and 5% weight loss target respectively, after a minimum 72 weeks exposure, highlighting a notable effectiveness gap. Critically, we identified that Metformin co-therapy acted as a modifier of the 'rebound effect,' significantly attenuating (median 1·9 - 2·6%, p < 0.0001) weight regain compared to semaglutide or tirzepatide monotherapy.Conclusion
Our findings confirm real-world AOM effectiveness and reveal challenges of the 'one-size-fits-all' approach of current pharmacotherapy. The marked inter-individual variability suggests that stratified, personalized pharmacotherapy is essential to transform transient weight loss into sustainable metabolic health.Clinical trial
Not applicable.
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BibTeX
@article{ruan2026current,
title = {{Current status of anti-obesity medications and performance, an EHR based survey.}},
author = {Xiaoyang Ruan and Rui Li and Liwei Wang and Shuyu Lu and Andrew Wen and Murali Sameer and Hongfang Liu},
journal = {BMC endocrine disorders},
year = {2026},
month = jul,
doi = {10.1186/s12902-026-02423-7},
url = {https://europepmc.org/article/MED/42897521},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Current status of anti-obesity medications and performance, an EHR based survey.
AU - Xiaoyang Ruan
AU - Rui Li
AU - Liwei Wang
AU - Shuyu Lu
AU - Andrew Wen
AU - Murali Sameer
AU - Hongfang Liu
PY - 2026
DA - 2026/07/01
JO - BMC endocrine disorders
DO - 10.1186/s12902-026-02423-7
UR - https://europepmc.org/article/MED/42897521
AB - Background While randomized clinical trials (RCTs) establish the efficacy of anti-obesity medications (AOMs), their real-world effectiveness, inter-individual variability, and weight regain post discontinuation remain poorly characterized across diverse, large scale populations.Methods Electronic health records with pharmacy dispensation of obesity or overweight individuals were retrieved from local UT-Physician and nationwide EPIC COSMOS databases. AOMs were analyzed for short to long-term effectiveness on obesity relevant metrics.Results From the two cohorts, 71,318 (11·7%) and 1 M (27·9%) individuals documented AOM exposures, respectively, with about 70% individuals experiencing more than one treatment session. Tirzepatide and Semaglutide outperformed other AOMs and were associated with up to 9·6[IQR:11]% and 6·2[IQR:11]% weight loss, respectively, and both improved blood pressure, HbA1c, and lipid profile. The median exposure durations were approximately 4·6 months for the two GLP-1/GIP AOMs, far short of the 72-week duration typically required for peak therapeutic benefit in RCTs. All AOMs showed substantial inter-individual variability in responses, regardless of exposure length. Substantial differences were found between RCT and real-world performance. For example, while Tirzepatide led both cohorts, nearly 50% and 25% of individuals didn't achieve the 10% and 5% weight loss target respectively, after a minimum 72 weeks exposure, highlighting a notable effectiveness gap. Critically, we identified that Metformin co-therapy acted as a modifier of the 'rebound effect,' significantly attenuating (median 1·9 - 2·6%, p < 0.0001) weight regain compared to semaglutide or tirzepatide monotherapy.Conclusion Our findings confirm real-world AOM effectiveness and reveal challenges of the 'one-size-fits-all' approach of current pharmacotherapy. The marked inter-individual variability suggests that stratified, personalized pharmacotherapy is essential to transform transient weight loss into sustainable metabolic health.Clinical trial Not applicable.
SN - 1472-6823
ER -