MON-109 Identifying Limiting Factors to Weight Loss and Prevention of Comorbidities in a Patient Population with Obesity

Introduction:  Obesity is a disease affecting 1/3 of our patients and is accompanied by numerous comorbidities, including pre-diabetes (preDM) and diabetes (DM).  Cause of obesity is often multifactorial with biochemical, genetic, and environmental factor contributions.   Underlying questions: Determine limiting factors to weight loss and improve weight loss interventions aimed at preventing obesity-related comorbidities. The first step is identifying the proportion of patients treated with medications with side effects of weight gain. Additionally, investigate weight loss correlation to A1c.   Methods: We reviewed charts of all new patients seen in our academic weight loss clinic from 2014 to 2017 and divided into DM, preDM, or neither based on initial point of care hemoglobin A1c (POC HbA1c). Patients having bariatric surgery during study were excluded.  Data collected at initial and return visits: weight, BMI, medications, POC HbA1c.   Results: We reviewed 649 patients with full data on 308 patients. Mean age was 50.7 (SD 12.6), mean initial weight 120.4kg (SD 28.5), and BMI 43.3 (SD 9.5). 79.8% were women and 20.2% were men. Mean initial HbA1c was 6.7% (SD 1.4) with concurrent fasting glucose 155.2 mg/dL (SD 61.6). Initial HbA1c revealed 64.9% had preDM and 35.1% had DM. 39.6% preDM and 7.0% DM diagnoses were new. On initial visit, 63.3% of preDM group and 83.1% of DM group took medications associated with weight gain. Most common classes were anti-depressant, DM, and neurologic/mood stabilizing medications. Mean A1c change over the study was 0.09 (SD 0.56) in preDM group and -0.02 (SD 1.87) in DM group. BMI change was  -0.71 (SD 3.75) and -1 (SD 3.68), respectively. 15.8% of pre-DM patients progressed to DM.   Discussion: Use of medications associated with weight gain is common. Identifying and limiting these, especially in persons at risk of weight gain, could be beneficial and potentially prevent obesity-related complications. A growing number of medications, especially for DM, are associated with weight loss. These should be considered for patients with both DM and obesity. POC A1c is a time-efficient tool to identify those with or at-risk of DM. Many patients with obesity who were unaware of a diagnosis of preDM or DM were identified in our study. Weight loss is important to reduce A1c and prevent progression from preDM to DM. Our patients had a small reduction in BMI with slight A1c increase in preDM group and A1c decrease in DM group. Only 15.8% of preDM progressed to DM and further data is necessary to determine correlation of BMI and A1c in this group. Conclusion: Use of medications associated with weight gain is common, as is underlying preDM and DM among patients presenting for care in an academic center. Choosing medications that are weight neutral or associated with weight loss is important in those at risk for weight gain.  POC A1c is useful to identify patients with preDM and DM in a weight loss clinic.