Background: We aimed to assess the utilization of anti-obesity medications (AOM) in patients with obesity utilizing a population level database. Methods: We performed a retrospective cohort study using an electronic health record-derived database (Explorys, IBM Watson Health) from 01/2017 to 9/2022. Adults with obesity body mass index (BMI) > 30 kg/m2 (Class I, II, III) were identified and the usage of AOM was analyzed (semaglutide, liraglutide, naltrexone/bupropion, orlistat, metformin, phentermine, topiramate, and phentermine/topiramate). Patients with a history of diabetes mellitus (DM) were subgrouped within the anti-diabetes medication for subgroup analysis. Patients with a history of migraines or seizure disorders were excluded from the topiramate group. Results: A total of 3,339,630 patients with obesity were included. Prevalence of AOM prescription was as followed: semaglutide (0.71%), liraglutide (2.58%), naltrexone/bupropion (0.82%), orlistat (0.24%), metformin with DM (17.82%), metformin without DM (2.26%), phentermine (3.98%), topiramate (2.24%), and phentermine/ topiramate (0.61%). Patients with obesity class III (BMI >40) had increased utilization of AOM compared to patients with BMI <40: semaglutide (OR 1.32; p<0.001), liraglutide (OR 1.58; p<0.001), naltrexone/bupropion (OR 1.46; p<0.001), orlistat (OR 1.60; p<0.001), metformin with DM (OR 1.25; p<0.001), metformin without DM (OR 1.75; p<0.001), phentermine (OR 1.38; p<0.001), topiramate (OR 1.60; p<0.001), phentermine/topiramate (OR 1.24; p<0.001). Conclusions: Amongst patients with obesity, prescription of AOM is very low and it appeared that AOM use is increased in late-stage obesity (severe/class III) rather than earlier in the disease process (class I, II). Further investigations into barriers of prescription of AOM are needed to increase utilization and prescription of AOM for patients with obesity.