891. Minimum Manufacturing Costs and National Prices for Weight Loss Treatments, as Potential Mitigation for Anti-Retroviral Related Weight Gain in HIV

Background Weight gain is being observed for a wide range of antiretroviral treatments. Weight gains are higher for people taking first-line integrase inhibitor based treatments, especially those including TAF/FTC. Weight gains are higher for women and people of colour. Clinical obesity increases the risks of cardiovascular disease, diabetes, adverse birth outcomes and could lower survival rates. Anti-obesity treatments are needed to supplement lifestyle interventions and counteract progressive weight gains, but are not routinely provided as part of HIV care. Methods Costs of production for FDA-recommended weight loss treatments and anti-diabetic medications (orlistat, naltrexone-bupropion, topiramate, phentermine, semaglutide, liraglutide and metformin) were estimated using an established and published methodology based on costs of active pharmaceutical ingredients (API), extracted from the global shipping records database Panjiva. This was compared with national drug list price data from a range of low, medium, and high-income countries. Figure 1. Example of methodology for calculating the estimated minimum cost of production for orlistat Results Weight loss and anti-diabetic treatments can be generically manufactured at low per-course costs, e.g. &85 per person per year for oral treatments such as orlistat and &1 per person per month for metformin. However, prices for a year of treatment with orlistat are as high as &1,205 in the USA and as low as &11 in Vietnam. In comparison, a month of ARV treatment costs about &15 via global health institutions like CHAI. Price for injectable (subcutaneous) treatments were higher, ranging from &1,985 for liraglutide in USA to &330 in Morocco, whilst they could potentially be profitably sold for &155 for a 12-week course. No export price data was available for semaglutide. When compared against international list prices, we found wide variations between countries. Table 1. Summary of drug prices and minimum cost estimates Figure 2. Orlistat course costs in a range of countries, compared with estimated minimum cost Figure 3. Liraglutide course costs in a range of countries, compared with estimated minimum cost Conclusion We show that weight loss treatments can be manufactured and sold profitably for low prices, but have a wide price range between countries. Government and non-governmental healthcare systems should be evaluating weight loss agents for inclusion within ART programmes. Disclosures All Authors: No reported disclosures

Effect of tailoring on weight loss among young adults receiving digital interventions: an 18 month randomized controlled trial

Weight loss outcomes among young adults in technology-based programs have been equivocal. The purpose of this study was to deliver digital weight loss treatments to young adults and examine the 6, 12, and 18 month effects on weight loss. Young adults with overweight/obesity (N = 459; 23.3 ± 4.4 years) were recruited from two university sites and randomly assigned to receive through Facebook and text messaging either personalized (TAILORED; n = 150) or generic (TARGETED; n = 152) weight loss information, messages, and feedback or general healthy body content (e.g., body image, sleep; CONTROL; n = 157). The study was powered to detect a 2.1-kg difference at all time points with the primary outcome being 18 months. There was no overall effect of treatment group on 6, 12, or 18 month weight loss (ps = NS). However, at 6 months, those in TAILORED who were highly engaged (completing >66%) lost more weight compared to CONTROL (−2.32 kg [95% confidence intervals: −3.90, −0.74]; p = .004), with the trend continuing at 12 months. A significant baseline body mass index (BMI) by treatment group interaction (p = .004) was observed at 6 months. Among participants in the lowest baseline BMI category (25–27.5 kg/m2), those in TAILORED lost 2.27 kg (−3.86, −0.68) more, and those in TARGETED lost 1.72 kg (−3.16, −0.29) more than CONTROL after adjusting for covariates. Among participants with a BMI between 27.5 and 30 kg/m2, those in TAILORED lost 2.20 kg (−3.90, −0.51) more than participants in TARGETED. Results did not persist over time with no treatment interaction at 12 or 18 months. Initial body weight should be considered when recommending weight loss treatments for young adults. More intensive interventions or stepped care approaches may be needed for young adults with obesity.

Relationships Between Learned Self-Regulatory Skills and Changes in Weight-Loss Behaviors: Mediation by Barriers Self-Efficacy

This study aimed to assess changes in learned self-regulatory skills and barriers self-efficacy associated with theory-based behavioral weight-loss treatments with different curricular emphases, and to evaluate mechanisms of short- and long-term changes in exercise and eating behaviors via self-regulatory skills usage to inform theory and improve lagging intervention effects. Women with obesity volunteered and were randomly allocated into 1-year community-based behavioral weight-loss treatments with either a high ( n = 37) or moderate ( n = 41) focus on building self-regulatory skills to overcome lifestyle barriers. They were periodically assessed on measures of exercise- and eating-related self-regulatory skill usage, exercise- and eating-related barriers self-efficacy, exercise outputs, fruit/vegetable intake, and body composition. Reductions in weight and waist circumference, increases in exercise- and eating-related self-regulation and barriers self-efficacy, and increases in exercise and fruit/vegetable intake were each significant overall, and significantly greater in the group with a high self-regulatory skills-building focus. Change in barriers self-efficacy significantly mediated relationships between self-regulation change and changes in exercise outputs and fruit/vegetable intake from both baseline–Month 6 and baseline–Month 12. Change in barriers self-efficacy also significantly mediated relationships between change in self-regulation for eating from baseline–Month 3 and long-term changes in self-regulation for eating. Findings supported tenets of social cognitive, self-efficacy, and self-regulation theories: and indicated the importance of emphasizing, and facilitating a high amount of instruction and rehearsal time for self-regulatory skills development within behavioral weight-loss treatments. The ability to nurture self-efficacy through overcoming lifestyle barriers was also indicated.

Timing of Breakfast, Lunch, and Dinner. Effects on Obesity and Metabolic Risk

(1) Background: Eating is fundamental to survival. Animals choose when to eat depending on food availability. The timing of eating can synchronize different organs and tissues that are related to food digestion, absorption, or metabolism, such as the stomach, gut, liver, pancreas, or adipose tissue. Studies performed in experimental animal models suggest that food intake is a major external synchronizer of peripheral clocks. Therefore, the timing of eating may be decisive in fat accumulation and mobilization and affect the effectiveness of weight loss treatments. (2) Results: We will review multiple studies about the timing of the three main meals of the day, breakfast, lunch and dinner, and its potential impact on metabolism, glucose tolerance, and obesity-related factors. We will also delve into several mechanisms that may be implicated in the obesogenic effect of eating late. Conclusion: Unusual eating time can produce a disruption in the circadian system that might lead to unhealthy consequences.

The role of familism in weight loss treatment for Mexican American women

Mexican American women are disproportionately affected by overweight/obesity and the health complications accompanying them, but weight loss treatments are less successful in this ethnic group. High levels of familism, a value reflecting obligation to family that supersedes attention to oneself, interfere with weight loss for Mexican American women. This mixed methods study investigated overweight Mexican American women’s beliefs about how familism, and Mexican American culture, might hinder weight loss success, and how treatments might be culturally adapted. Results suggest a need to support women in their commitment to family while also helping them make changes. Recommendations for culturally adapted treatments are made.