2007-P: Obesity Prevalence in the Patient Neighborhood and Outcomes of Antiobesity Medication Mediated by Treatment Continuation: Structured Equation Modeling Approach

Introduction and Objective: Outcomes of anti-obesity medications (AOM) in real-world differ from the controlled-trial reports. Persistence on AOM is the primary determinant of effectiveness, which could be influenced by various factors. We hypothesized that neighborhood obesity prevalence—affecting perceived need for continued AOM use—plays a critical role in predicting outcomes. Methods: Adults receiving incretin mimetic AOMs were identified from the University of Illinois Hospital and Health Sciences System. We adopted Andersen Health Service Utilization Behavior Model to explore the causal pathways from perceived need (neighborhood obesity rate and patient’s health status), predisposed components (demographics), and enabling components (insurance and wealth) to a latent health risk change (BMI and SBP change) through a latent treatment continuation factor (persistence and frequent pharmacy visits). Using a Path Model within a structured equation modeling framework, standardized coefficient (βstd) across the observed elements and latent factors were calculated. A positive indirect effect would indicate that the higher neighborhood obesity rate increases health risk. Results: We analyzed the 1642 AOM user data. Neighborhood obesity rate negatively impacts on treatment continuation (βstd = -0.052, p=0.041). Treatment continuation reduced health risk (βstd = -0.389, p<0.001). The indirect impact of the neighborhood obesity rate on health risk through treatment continuation was positive and marginally significant (βstd= 0.020, p= 0.053). The Path Model demonstrated good fit. Conclusion: Neighborhood obesity prevalence negatively influences treatment continuation that reduced benefits of AOM. Effective obesity management has to be complemented by holistic strategies, including community engagement. A larger-scale analysis is warranted to precisely estimate the impact of patient-and community-level elements on care continuation and AOM outcomes. Disclosure K. Kim: Other - Research Fellowship; Current; Takeda Pharmaceutical Company Limited. M. Alnuman: None. T. Dai: None. J.Y. Osei: None. G.S. Calip: Employee; Current; AbbVie Inc. B. Layden: None. D. Touchette: Advisory Panel; Current; Boehringer Ingelheim International GmbH. J. Krive: None. T. Lee: None. Funding NIH/NIDDK (1K01DK139458)