Introduction:
Changes in cardiometabolic risk following discontinuation of anti-obesity medications (AOMs), particularly glucagon-like peptide-1 agonists, have not been well characterized in real-world settings. Objective of this study was to project the trajectory of body-mass index (BMI) and blood pressure (BP) during and post  AOM use.

Methods:
A retrospective cohort study was conducted using healthcare records from January 2016 to March 2024. Adults with a BMI ≥25 kg/m² receiving AOMs for weight management were included. Discontinuation was defined by the end of the AOM supply from the last dispensing date. Cumulative discontinuation rates were calculated using Kaplan-Meier estimates. Linear mixed-effect modeling was used to project changes in BMI and SBP during one year of AOM use and one year post-discontinuation, adjusting for baseline BMI and AOM effect.

Results:
A total of 1,679 individuals (91% female; mean age 43 years) were included. Most patients were treated with phentermine-topiramate (71%) or semaglutide (20%). Discontinuation rates ranged from 30–64% at 6 months and 50–80% at 1 year. Continuous AOM use was associated with a projected one-year reduction of 2.8 kg/m² in BMI and 1.3 mmHg in SBP from average baseline values (BMI: 40 kg/m²; SBP: 131 mmHg). Following discontinuation, a projected regain of 3.4 kg/m² in BMI and 4.2 mmHg in SBP was observed.

Conclusion:
Greater rebounds in BMI and SBP were observed after AOM discontinuation compared to the average benefits during use, highlighting the need for further investigation into the effects of AOM persistence and discontinuation.

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