2026 Southeastern Residency Conference

Title: Weight Loss Medication Tapering and Its Effect on Sustainability of Decreased Body Weight
Authors: Mary Christine Buehner, Paul Strange

Background:

Obesity affects the lives of more than 1 billion people worldwide. For this population, long-term maintenance of weight loss proves difficult as lifestyle modifications alone are often unsustainable due to components such as adherence and alterations in metabolism. Although management of weight loss with medications has proven to be effective for upwards of three years in previously completed randomized controlled trials, outcomes beyond the use of medications have not been consistently measured. Additionally, there is limited information available concerning the process of tapering individuals off of medication management and the corresponding long-term results associated with this method. The Ralph H. Johnson VA Healthcare System (RHJ VAHS) has previously utilized both the abrupt discontinuation and tapering off of weight loss medications, but it has yet to be determined which method allows patients increased maintenance of weight loss.

Methods:

This retrospective cohort analysis utilized Electronic Health Record (EHR) data available through the VA Computerized Patient Record System (CPRS) and the VISTA pharmacy database for all patients treated in a Ralph H Johnson VA Primary Care Clinic setting and prescribed an FDA-approved weight loss medication for the indication of obesity for at least 6-months between January 1, 2020, and February 1, 2025. Once evaluated, patients were allocated to two cohorts in a 3:1 fashion – those whose medications had been abruptly discontinued and those who had been tapered prior to discontinuation (or decreased to a maintenance dose appropriate for treatment of comorbid conditions). The primary endpoint was to determine if patients who were tapered off medications were able to maintain more than the abruptly discontinued cohort’s anticipated maintenance amount of 50% of total weight lost after treatment completion. The secondary endpoints analyzed weight loss between the cohorts over 10% at year two and 5% at year 3, as well as mean percentage of weight loss maintained at year 1, year 2, and year 3 (or end of study period). Other secondary outcomes considered in analysis were those patients lost to follow-up and those who were able to lose additional weight following year 1 therapy completion.

Results:

The primary outcome did not demonstrate statistical significance between the abruptly tapered cohort and the tapered cohort (53.8% maintained >50% total body weight loss at year 1 vs. 46.2%; OR 1.36 (0.97-1.91); p=0.0759). Secondary outcomes showed a significantly higher percentage of weight loss at year 1 in the abrupt cohort (-2.6±7.7% (median -0.7%) vs. -0.8±7.2% (median +0.5%); p=0.0082). However, data extraction determining efficacy became limited when a statistically significant increase in loss to follow-up impacted the tapered cohort from year 2 forward (69.8% vs. 57.4%; p=0.0034; OR=0.58).

Conclusion:

No significant difference was found in ability to maintain >50% of total weight loss at year 1 between patients abruptly discontinued and those tapered off of weight loss medications. Weight loss in subsequent years was difficult to analyze due to increased loss to follow-up in the tapered cohort demonstrating a need for consistent and efficient patient monitoring.