Association between ZIP-Code Level, Obesity Prevalence, and Antiobesity Medication Persistence

Introduction and Objective: Persistence with anti-obesity medications (AOMs) remains low despite their increasing use. Neighborhood obesity prevalence may influence health behaviors and treatment continuation by serving as a social norm. This study examines the association between local obesity prevalence and AOM persistence. Methods: We conducted a retrospective cohort study of adults with obesity (BMI ≥ 30 kg/m2) at the University of Illinois hospital (UI Health) who filled an incretin mimetic AOM between 2020 and 2024. Treatment persistence was measured as the proportion of days covered over 6 months. Neighborhood obesity prevalence was assessed using five-digit zip code-level estimates from the CDC PLACES Project. Results: Among 1,335 patients (mean age 44.6, 91% female), the mean proportional persistence was 37.4% (SD 26.1%). Zip code-level obesity prevalence was not significantly correlated with either average persistence within the zip-code area (Pearson r = -0.076, p = 0.26) or patient-level persistence (Pearson r = -0.025, p-value = 0.37). This association remained non-significant after adjusting for age and gender (β = -0.001, SE = 0.001, p = 0.34). Conclusion: The negative correlation between area-level obesity prevalence and AOM persistence was not statistically significant. Further research is needed to explore contextual and behavioral determinants of treatment continuation Disclosure: J.Y. Osei: None. L. Khoja: Other - postdoctoral fellow; Current; Takeda Pharmaceutical Company Limited. M. Alnuman: None. K. Kim: Other - Research Fellowship; Current; Takeda Pharmaceutical Company Limited.