{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T12:19:49Z","timestamp":1789129189479,"version":"build-2803163510"},"posted":{"date-parts":[[2026,9,8]]},"group-title":"Endocrinology (including Diabetes Mellitus and Metabolic Disease)","reference-count":43,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T00:00:00Z","timestamp":1788825600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,9,8]]},"abstract":"<jats:title>Structured Abstract<\/jats:title>\n                <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>To characterize adults with obesity in a large integrated health system.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We created a cross-sectional cohort of adults with at least one body mass index (BMI) value &gt;=30 kg\/m2 in the prior 18 months, a recent in-person outpatient visit, and an assigned primary care provider. Electronic health record data were transformed into a patient-level analytic dataset and linked to neighborhood-level social determinants of health. Diagnoses, laboratory values, vital signs, and prescriptions were curated using reproducible phenotype definitions and internally reviewed vocabularies.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The registry included 280,186 adults, of whom 48% had class I obesity. The cohort was 63% female, 27% Black, and 14% lived in areas with high or very high deprivation. Common comorbidities included hypertension, type 2 diabetes, depression, and anxiety. HbA1c and cholesterol measurements were absent in more than 40% of the cohort during the prior two years. Overall, 22% of patients received a prescription for at least one weight loss drug in the past 2 years, including 18% who received a weight-loss-approved GLP-1 receptor agonist.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>This care-engaged obesity cohort was characterized by high representation of women and socially vulnerable populations, substantial cardiometabolic screening gaps, and broad adoption of GLP-1 agonists.<\/jats:p>\n                <\/jats:sec>","DOI":"10.64898\/2026.09.04.26361064","type":"posted-content","created":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T03:25:53Z","timestamp":1788924353000},"source":"Crossref","is-referenced-by-count":0,"title":["Obesity in the GLP-1 Era: Clinical Characteristics and Prescribing Patterns in a Large Integrated Health System"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7310-6525","authenticated-orcid":false,"given":"Brian J","family":"Wells","sequence":"first","affiliation":[{"name":"Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Division of Public Health Sciences, Winston Salem, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1834-7398","authenticated-orcid":false,"given":"Kristin M","family":"Lenoir","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Division of Public Health Sciences, Winston Salem, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8079-8504","authenticated-orcid":false,"given":"Michael","family":"Webster-Clark","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Division of Public Health Sciences, Winston Salem, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4447-6196","authenticated-orcid":false,"given":"Nicholas M","family":"Pajewski","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Division of Public Health Sciences, Winston Salem, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-8373-3855","authenticated-orcid":false,"given":"Amanda T","family":"Pons-Junkins","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Division of Public Health Sciences, Winston Salem, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7177-1185","authenticated-orcid":false,"given":"Michelle M","family":"Mielke","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Division of Public Health Sciences, Winston Salem, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"54368","reference":[{"key":"2026091104150833000_2026.09.04.26361064v1.1","doi-asserted-by":"publisher","DOI":"10.2196\/58722"},{"key":"2026091104150833000_2026.09.04.26361064v1.2","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2022.08.045"},{"key":"2026091104150833000_2026.09.04.26361064v1.3","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.12567"},{"key":"2026091104150833000_2026.09.04.26361064v1.4","doi-asserted-by":"publisher","DOI":"10.2196\/65440"},{"key":"2026091104150833000_2026.09.04.26361064v1.5","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-024-21061-z"},{"key":"2026091104150833000_2026.09.04.26361064v1.6","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.18977"},{"key":"2026091104150833000_2026.09.04.26361064v1.7","doi-asserted-by":"publisher","DOI":"10.7326\/M18-3337"},{"key":"2026091104150833000_2026.09.04.26361064v1.8","doi-asserted-by":"publisher","DOI":"10.20944\/preprints202511.1923.v1"},{"key":"2026091104150833000_2026.09.04.26361064v1.9","unstructured":"Epocrates. Epocrates online drug database [Internet]. Watertown (MA): Epocrates; 2025. Available from: https:\/\/www.epocrates.com. Accessed November 30, 2025."},{"key":"2026091104150833000_2026.09.04.26361064v1.10","unstructured":"First Databank. EHR drug database [Internet]. San Francisco (CA): First Databank; 2025. Available from: https:\/\/www.fdbhealth.com\/applications\/electronic-health-records. Accessed November 30, 2025."},{"key":"2026091104150833000_2026.09.04.26361064v1.11","doi-asserted-by":"crossref","unstructured":"Flanagan, B.E. , Gregory, E.W. , Hallisey, E.J. , Heitgerd, J.L. , Lewis, B. , 2011. A Social Vulnerability Index for Disaster Management 8.","DOI":"10.2202\/1547-7355.1792"},{"key":"2026091104150833000_2026.09.04.26361064v1.12","unstructured":"Gilbert, D ., 2025. Patients navigate an \u2018absolutely insane\u2019 maze to afford weight-loss drugs. The Washington Post."},{"key":"2026091104150833000_2026.09.04.26361064v1.13","doi-asserted-by":"publisher","DOI":"10.1093\/jamiaopen\/ooad078"},{"key":"2026091104150833000_2026.09.04.26361064v1.14","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2024.4789"},{"key":"2026091104150833000_2026.09.04.26361064v1.15","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2102953"},{"key":"2026091104150833000_2026.09.04.26361064v1.16","unstructured":"Joszt L. FDA approves oral semaglutide as first GLP-1 pill for weight loss [Internet]. American Journal of Managed Care. 2025. Available from: https:\/\/www.ajmc.com\/view\/fda-approves-oral-semaglutide-as-first-glp-1-pill-for-weight-loss. Accessed March 22, 2026."},{"key":"2026091104150833000_2026.09.04.26361064v1.17","doi-asserted-by":"publisher","DOI":"10.1055\/s-0039-1693685"},{"key":"2026091104150833000_2026.09.04.26361064v1.18","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0b013e318257dd67"},{"key":"2026091104150833000_2026.09.04.26361064v1.19","doi-asserted-by":"publisher","DOI":"10.13063\/2327-9214.1052"},{"key":"2026091104150833000_2026.09.04.26361064v1.20","doi-asserted-by":"publisher","DOI":"10.13063\/2327-9214.1244"},{"key":"2026091104150833000_2026.09.04.26361064v1.21","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1802313"},{"key":"2026091104150833000_2026.09.04.26361064v1.22","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2022-065425"},{"key":"2026091104150833000_2026.09.04.26361064v1.23","doi-asserted-by":"publisher","DOI":"10.1002\/osp4.726"},{"key":"2026091104150833000_2026.09.04.26361064v1.24","doi-asserted-by":"publisher","DOI":"10.1089\/dtom.2025.0027"},{"key":"2026091104150833000_2026.09.04.26361064v1.25","doi-asserted-by":"publisher","DOI":"10.2196\/14777"},{"key":"2026091104150833000_2026.09.04.26361064v1.26","doi-asserted-by":"publisher","DOI":"10.1038\/s41380-018-0017-5"},{"key":"2026091104150833000_2026.09.04.26361064v1.27","unstructured":"National Library of Medicine. RxNorm [Internet]. Bethesda (MD): National Library of Medicine; 2025. Available from: https:\/\/www.nlm.nih.gov\/research\/umls\/rxnorm\/index.html. Accessed November 30, 2025."},{"key":"2026091104150833000_2026.09.04.26361064v1.28","doi-asserted-by":"publisher","DOI":"10.1093\/jamia\/ocab265"},{"key":"2026091104150833000_2026.09.04.26361064v1.29","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2008.08.022"},{"key":"2026091104150833000_2026.09.04.26361064v1.30","doi-asserted-by":"publisher","DOI":"10.7326\/ANNALS-24-02870"},{"key":"2026091104150833000_2026.09.04.26361064v1.31","doi-asserted-by":"publisher","DOI":"10.1093\/gerona\/glz017"},{"key":"2026091104150833000_2026.09.04.26361064v1.32","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-025-04051-5"},{"key":"2026091104150833000_2026.09.04.26361064v1.33","doi-asserted-by":"crossref","unstructured":"Peters, W. , Monk Fries, T. , Middolu, S. , Wilson, L. , Lee, S.H ., 2026. Real-world comparative effectiveness of semaglutide 2.4 mg versus other commercially available medications for chronic weight management in adults with obesity in the United States: a pragmatic clinical study, in: Value in Health. Presented at the ISPOR 2026, Philadelphia, PA, USA.","DOI":"10.1016\/j.jval.2026.03.021"},{"key":"2026091104150833000_2026.09.04.26361064v1.34","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwq433"},{"key":"2026091104150833000_2026.09.04.26361064v1.35","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.57349"},{"key":"2026091104150833000_2026.09.04.26361064v1.36","doi-asserted-by":"publisher","DOI":"10.1001\/jamahealthforum.2025.4258"},{"key":"2026091104150833000_2026.09.04.26361064v1.37","doi-asserted-by":"publisher","DOI":"10.1111\/dom.14367"},{"key":"2026091104150833000_2026.09.04.26361064v1.38","unstructured":"Tchang, B.G. , Aras, M. , Kumar, R.B. , Aronne, L.J. , 2024. Table 2. [FDA Approved Anti-Obesity Medications]. [WWW Document]. URL https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK279038\/table\/pharma-treat-obese.T.fda_approved_antiob\/ (accessed 3.22.26)."},{"key":"2026091104150833000_2026.09.04.26361064v1.39","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2023.8438"},{"key":"2026091104150833000_2026.09.04.26361064v1.40","unstructured":"U.S. Census Bureau. American Community Survey (ACS) [Internet]. Washington (DC): U.S. Census Bureau; 2025. Available from: https:\/\/www.census.gov\/programs-surveys\/acs.html. Accessed April 1, 2026."},{"key":"2026091104150833000_2026.09.04.26361064v1.41","unstructured":"United States Department of Agriculture Economic Research Service. Rural-Urban Commuting Area (RUCA) codes [Internet]. Washington (DC): USDA Economic Research Service; 2026. Available from: https:\/\/www.ers.usda.gov\/data-products\/rural-urban-commuting-area-codes. Accessed April 1, 2026."},{"key":"2026091104150833000_2026.09.04.26361064v1.42","doi-asserted-by":"publisher","DOI":"10.2337\/dc20-0063"},{"key":"2026091104150833000_2026.09.04.26361064v1.43","unstructured":"World Health Organization. Anatomical Therapeutic Chemical (ATC) classification system [Internet]. Geneva: World Health Organization; 2025. Available from: https:\/\/www.who.int\/tools\/atc-ddd-toolkit\/atc-classification. Accessed November 30, 2025."}],"container-title":[],"original-title":[],"link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.64898\/2026.09.04.26361064","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T11:15:19Z","timestamp":1789125319000},"score":1,"resource":{"primary":{"URL":"http:\/\/medrxiv.org\/lookup\/doi\/10.64898\/2026.09.04.26361064"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,8]]},"references-count":43,"URL":"https:\/\/doi.org\/10.64898\/2026.09.04.26361064","relation":{},"subject":[],"published":{"date-parts":[[2026,9,8]]},"subtype":"preprint"}}