WeightWatchers combined with weight loss medications may alter alcohol consumption, study finds

Researchers at Henry Ford Health, collaborating with WeightWatchers International, report that more than 40% of individuals using popular weight loss medications while participating in a WeightWatchers clinic decreased their alcohol use.

Previous associations have been noted between specific drugs and a lower incidence of alcohol use disorder. Health-conscious behavioral changes in weight management programs are also linked to reduced alcohol consumption. Examining alcohol use among individuals using various medications for weight loss could offer insights into behavioral versus medication effects on alcohol reduction.

In a study, “Alcohol Use and Antiobesity Medication Treatment,” published in JAMA Network Open, researchers analyzed data from participants in the WeightWatchers telehealth weight management program between January 2022 and November 2023.

Participants had a mean age of 43.17 years and a mean body mass index (BMI) of 35.97; 86.0% were female. Most participants (86.2%) were prescribed a second-generation glucagon-like peptide-1 receptor agonist (GLP-1 RA). Approximately half (53.3%) reported alcohol use at baseline.

Medications included metformin, bupropion combined with naltrexone (Contrave), liraglutide (Saxenda), dulaglutide (Trulicity), tirzepatide (Zepbound), and semaglutide (Ozempic, Rybelsus). Some of the drugs used in the study are not FDA-approved for weight loss, and others were not approved during the study timeframe.

Among the 7,491 participants reporting alcohol use at baseline, 52.4% reported no change, 45.3% decreased their consumption, and 2.3% reported an increase after joining the WeightWatchers telehealth weight management program and initiating what the authors refer to as anti-obesity medication (AOM). Participants with higher obesity levels and higher baseline alcohol use were more likely to reduce their alcohol consumption.

Individuals receiving bupropion and naltrexone had the greatest likelihood of decreasing alcohol use compared to those taking other drugs. Naltrexone is FDA-approved for treating alcohol dependence due to its ability to reduce cravings and diminish rewarding effects.

Bupropion has known risks when used with alcohol, with increased seizure risk and negative behavioral effects, and patients receiving the combined version would have been advised by their physician or pharmacist of the interaction warnings.

After statistically adjusting for weight loss, the significance of bupropion and naltrexone’s effect disappeared, suggesting the reduction may be mediated by weight loss rather than the medication itself. This is a remarkable finding considering naltrexone’s known pharmacological effects in other study settings.

If AOMs reduce alcohol use partly by promoting weight loss, adjusting for weight loss could obscure this effect. This would minimize the apparent role of AOMs in alcohol consumption reduction.

For instance, if GLP-1 RAs reduce the rewarding effects of both food and alcohol through similar neural mechanisms, weight loss is not a confounder but a mediator of alcohol use reduction. In this case, adjusting for weight loss might downplay the contribution of AOMs to alcohol use changes.

Participants using metformin reported the least decrease in alcohol use, potentially attributed to engagement in the weight management program and associated behavioral strategies encouraging reduced alcohol intake, as this would hold for all participants as they were all enrolled in the same program.

Problematic aspects of the study design

Several limitations affect the interpretation of the study’s findings. The absence of a control group participating in the weight management program without anti-obesity medications makes it difficult to isolate the effects of medications from behavioral interventions. Inclusion of such a group could have clarified whether behavioral changes alone influence alcohol reduction.

Statistical adjustments for weight loss may obscure the direct effects of medications on alcohol consumption. If anti-obesity medications reduce alcohol use partly by promoting weight loss, adjusting for weight loss might minimize the apparent role of the medications.

Potential conflicts of interest exist, as several authors are employees of WeightWatchers International, which provides the weight management program and sells a medication viewed favorably in the study. This connection could introduce bias in reporting results favorably for the company’s programs and products.

Further research is needed to disentangle the effects of medications from behavioral interventions in influencing alcohol use.

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