Alcohol use and anti-obesity medication treatment

Anti-obesity medications (AOMs), including glucagon-like peptide-1 receptor agonists (GLP-1 RAs), are effective for achieving weight loss. Additionally, GLP-1 RA use was associated with lower incidence and recurrence of alcohol use disorder. 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. A study examined changes in alcohol use among individuals enrolled in a Telehealth weight management program after initiation of an AOM.
Individuals eligible for this cohort study were enrolled in the WeightWatchers (WW) Clinic telehealth medical weight management program. 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 categorised 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 enrolment at the WW Clinic. 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. Participants also reported their weekly alcohol use prior to AOM initiation and again at the time of refill. Only 0.8% of individuals did not complete the refill survey. Participants who decreased alcohol use were compared with those who did not decrease use after initiation of an AOM.
This study included 14 053 participants. Most participants (86.2%) were prescribed a second-generation GLP-1 RA. 52.2% of participants who reported drinking any alcohol at baseline had a decrease in alcohol use. Among 7,491 participants with alcohol use at baseline, 3,395 (45.3%) reported decreasing a category of alcohol use, 3,923 (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. Individuals receiving bupropion and naltrexone had a greater likelihood of reporting decreases in alcohol use compared with metformin. However, this was no longer significant after controlling for weight loss.
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 alcohol and GLP-1 RAs may attenuate the rewarding effects of alcohol, similar to food. Unexpectedly, participants using metformin also reported a decrease in alcohol use. Researchers say that 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. Enrolled individuals may have greater motivation for health behaviour change than non–treatment seeking individuals. Future research would benefit from a randomised trial comparing AOMs with a placebo-controlled or nonpharmacological weight management group.
Source: Miller-Matero LR, Yeh H, Ma L, et al. Alcohol Use and Antiobesity Medication Treatment. JAMA Netw Open. 2024;7(11):e2447644.