Abstract
OBJECTIVES: Obesity is a leading risk factor for global morbidity and mortality, associated with significant healthcare costs that exceed US$260 billion annually in the USA. Weight cycling, the repeated pattern of intentional weight loss followed by unintentional regain, can exacerbate obesity-related health complications. This study aimed to assess the health economic consequences of weight cycling in patients with obesity defined by a body mass index (BMI) ≥30 kg/m², comparing 'weight cyclers' with 'non-cyclers', and evaluating the impact of a high-protein oral nutritional supplement (HP-ONS) as a maintenance strategy following weight loss via glucagon-like peptide-1 receptor agonists (GLP-1RAs). DESIGN: Lifetime state transition modelling study with monthly cycles to simulate obesity-associated disease progression. SETTING: US healthcare system; societal perspective. PARTICIPANTS: Simulated cohort of adult patients with obesity (BMI ≥30 kg/m²), stratified by weight cycling status. INTERVENTIONS: Weight loss via GLP-1RAs with or without HP-ONS for weight maintenance. PRIMARY AND SECONDARY OUTCOME MEASURES: Key outcomes included costs per obesity-related event avoided, life years (LYs) gained and quality-adjusted life years (QALYs) gained, calculated from a US societal perspective. Transition probabilities for disease states were derived from meta-analyses and adjusted for weight cycling and other relevant risks. Costs and health utilities were based on published US studies with future costs discounted at 3% per year. Uncertainty was investigated by deterministic and probabilistic sensitivity analyses. RESULTS: Non-cyclers experienced 0.090 fewer obesity-associated events, gained 0.602 LYs and achieved 0.518 QALYs compared with cyclers, resulting in total cost savings of approximately US$4592 per patient. In the second scenario, the combination of GLP-1RA treatment and HP-ONS for weight maintenance yielded effective health outcomes with a cost-effectiveness ratio of US$24 276 per QALY gained, well within accepted cost-effectiveness thresholds in the USA, ranging from US$100 000 to US$150 000 per QALY gained. CONCLUSION: Weight cycling significantly impacts health and economic outcomes for patients with obesity, underscoring the need for effective weight management programmes, including the use of HP-ONS focused on sustained weight maintenance after weight loss to curtail associated risks and costs.