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I'm going to presume that the 20 percent is based on relative risk as opposed to absolute risk, as this is how the pharmaceuticals present their best statistics.
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I was assuming that the 20% decrease in risk is based purely on lab values:
Excess weight is associated with increased chance of heart attack and stroke. Lose weight and that risk factor is decreased when you lose weight on these drugs.
High BP is also a risk factor for heart attack and stroke, and losing weight also tends to lower BP, so that risk factor is decreased when you lose weight on these drugs.
Same with blood sugar. It said that the participants were not diabetics, but the bar has been set pretty high before diabetes is finally diagnosed. If they were pre-diabetics or even had only slightly higher than normal blood sugar readings, then losing weight could take them out of those categories.
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One thing that really concerns me is that the way the ones I know on them are acting, they seem to think that once they lose the weight (on what is a rather low fat, relatively low carb but also low protein diet), they will be able to keep it off just by sticking to the foods they ate to lose the weight.
But how are they going to do that?
On person taking them was stressed for several weeks over a health issue, started eating junk again, and regained some weight - in spite of being on a weight loss drug that suppresses appetite, as well as suppressing interest in food.
The other person is stressing over getting a refill on the drug, because demand is so high that pharmacies are estimating not being able to fill additional Rx's for a month or two.
At the same time, for one individual the appetite suppression seems to be wearing off at least a day before the next dose is due, and I'm hearing things like "thank goodness I take the next dose tomorrow". To me the return of a ravenous appetite on day 6 of each dose would be a huge red flag warning that the appetite suppression from this drug is fragile.
Still - both individuals seem to fully expect to lose all the weight necessary and then go off of the drug permanently - but somehow still be able to stick to the calorie levels they've been eating with the help of a drug that causes a nearly complete loss of interest in food - that somehow the way that the drug affects interest in food will be a permanent change.
Unless they go back on the drug every time they start to regain weight, I don't expect to see a good long term result. (And that's before even considering the potential for serious side effects)