Antiobesity Medications May Help Lower Alcohol Use, New Study Suggests

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Nearly half of individuals in a telehealth weight-loss program who consumed alcohol at baseline began drinking less after adding antiobesity medications (AOMs) to their weight-management regime, according to a recent cohort study.

Among the 7491 participants who reported alcohol use at the start of the study, 45.3% reported a decrease in use after AOM initiation, 52.4% reported no change, and 2.3% reported an increase, researchers led by Lisa R. Miller-Matero, PhD, of Henry Ford Health in Detroit, wrote in JAMA Network Open.

AOMs are effective for achieving weight loss and some, such as glucagon-like peptide 1 receptor agonists (GLP-1RAs), have been linked to 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,” researchers wrote. “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.”

Investigators analyzed data from 14 053 adults enrolled in the WeightWatchers Clinic telehealth medical weight-management program. All participants had initiated AOM therapy between January 2022 and August 2023 and refilled the same medication between October and November 2023. At baseline, participants were surveyed on their age, sex, race, height, weight, and weekly alcohol use and were resurveyed at the time of their AOM refill, according to the study.

Multivariate logistic regression was conducted to compare participants who decreased their alcohol use with those who did not after the initiation of an AOM. The analysis included covariates associated with weight and alcohol use, and statistical significance was set at P < .05.

Overall, the majority (86.2%) of participants were prescribed a second-generation GLP-1RA (ie, tirzepatide, semaglutide). Beyond second-generation GLP-1RAs, 5% of people were taking a first-generation GLP-1RA (ie, liraglutide and dulaglutide), 4.8% were prescribed bupropion/naltrexone, and 4% were taking metformin.

The average age of participants was 43 years, 86% were women, and 60% were White. At baseline, the average body mass index (BMI) was 35.97 kg/m². From the time of AOM initiation to the follow-up survey (average, 225 days), participants experienced a mean total weight loss of 12.68%, researchers reported. Also, 24.2% of the cohort had a decrease in alcohol use.

The data showed that decreased alcohol use was significantly more likely among women, in those with increasing obesity class, and among the heavier drinkers at baseline.

Gender disparities. Compared with women, men were less likely to reduce their weekly alcohol intake (adjusted OR [aOR] = 0.74; 95% CI, 0.64-0.85; P < .001).

Impact of obesity class, alcohol intake. Compared with participants who were overweight, those with higher classes of obesity were significantly more likely to cut down on alcohol intake after AOM initiation:

• Class I (BMI 30 to <35 kg/m²): aOR 1.26 (95% CI 1.07-1.48)
• Class II (BMI 35 to <40 kg/m²): aOR 1.49 (95% CI 1.26-1.77)
• Class III (BMI ≥40 kg/m²): aOR 1.63 (95% CI 1.36-1.96)

Moreover, heavier baseline drinkers were significantly more likely to reduce alcohol use. Compared with low-level drinkers (1–3 drinks/week for women, 1–6 drinks/week for men):

• Moderate drinkers (4–6 drinks/week for women, 7–14 for men): aOR 5.97 (95% CI, 5.17–6.91; P < .001).
• High-level drinkers (≥7 drinks/week for women, ≥15 for men): aOR 19.18 (95% CI, 13.25–28.86; P < .001).

Using metformin as a reference, only bupropion/naltrexone showed a higher likelihood of reduced alcohol consumption (aOR 1.42, 95% CI, 1.01–1.99), though this association was not significant after adjusting for weight loss. Age and race/ethnicity did not significantly affect alcohol reduction outcomes.

“Future research would benefit from a randomized trial comparing AOMs with a placebo-controlled or nonpharmacological weight management group,” Miller-Matero et al concluded.

Reference: Miller-Matero LR, Yeh HH, Ma L, et al. Alcohol use and antiobesity medication treatment. JAMA Netw Open. Published online November 26, 2024. doi:10.1001/jamanetworkopen.2024.47644