Responses to GLP-1RA in White and Black Adults With Obesity: Insights From Generalized Additive Mixed Models of EHR Data.

OBJECTIVE: This study examined racial differences in weight loss and clinical response to glucagon-like peptide-1 receptor agonist (GLP-1RA) therapy among adults with obesity using real-world data. METHODS: We retrospectively analyzed our institution's Research Data Warehouse (RDW) containing deidentified data from electronic health records (EHRs) from adults aged 18 years and older. EHR data from the University of Mississippi Medical Center RDW were analyzed for 7214 adults (2182 White; 5032 Black) prescribed injectable GLP-1RA between 2015 and 2025. Inclusion criteria were BMI ≥ 30 kg/m and ≥ 1 GLP-1RA. Longitudinal changes in patient data were modeled using generalized additive mixed models. RESULTS: At 2.5 years, White individuals experienced significantly greater body weight loss than Black individuals: -7.1% (95% CI -8.0%, -6.2%) versus -4.9% (95% CI -5.4%, -4.3%), as well as significantly larger reductions in estimated glomerular filtration rate, systolic blood pressure, and HbA1c. Semaglutide and tirzepatide were associated with the greatest improvements. Renal function decline was attenuated in both groups after therapy. CONCLUSIONS: In a large, diverse EHR cohort, GLP-1RA therapy was associated with significant weight, glycemic, and renal benefits that were attenuated in Black adults. These findings highlight the urgent need to understand mechanisms contributing to variable GLP-1RA outcomes among different populations.