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Farrell E, Nadglowski J, Hollmann E, le Roux CW, McGillicuddy D. "What would be left of me?" Patient perspectives on the risks of obesity treatment: An innovative health initiative stratification of obesity phenotypes to optimise future obesity therapy (IMI2 SOPHIA) qualitative study. OBESITY PILLARS 2024; 12:100129. [PMID: 39268014 PMCID: PMC11389537 DOI: 10.1016/j.obpill.2024.100129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2024] [Revised: 08/22/2024] [Accepted: 08/22/2024] [Indexed: 09/15/2024]
Abstract
Background The uptake of obesity treatments remains disproportionally low in people living with the disease, even with the advent and availability of GLP-1 agonists in recent years. Efforts to understand this discrepancy have centred on literature syntheses and Healthcare Professionals' (HCPs) perspectives on the barriers to obesity treatment. This study focuses on patient perspectives on the risks of obesity treatment. Method This qualitative study consisted of online focus groups with 30 adults with obesity from Europe and North America. The focus group discussions were recorded, transcribed verbatim and analysed thematically. Results Patients identified three risks associated with obesity treatment: (a) the risk that they can't access treatment; (b) the risk that they would fail to meet treatment expectations - their own, their HCPs and societal expectations, and (c) the risk that the treatment would be 'successful' but that they would lose their sense of self, their coping mechanisms and identity along with weight. Conclusion Understanding patient concerns about the risks of obesity treatment is essential to addressing obesity treatment inertia.
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Affiliation(s)
| | | | | | - Carel W le Roux
- School of Medicine, University College Dublin, Dublin, Ireland
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2
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Bomberg EM, Clark J, Rudser KD, Gross AC, Kelly AS, Fox CK. Effectiveness and predictors of weight loss response to phentermine plus lifestyle modifications among youth in a paediatric weight management clinical setting. Pediatr Obes 2024; 19:e13143. [PMID: 38886982 PMCID: PMC11239309 DOI: 10.1111/ijpo.13143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 05/12/2024] [Accepted: 05/17/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND Anti-obesity medications (AOMs) are promising lifestyle modification (LSM) adjuncts for obesity treatment, and phentermine is commonly prescribed in paediatric weight management clinics. Determining 'real-world' AOM effectiveness and characteristics predicting response is important. OBJECTIVES We sought to describe phentermine plus LSM effectiveness and identify baseline characteristics predicting response. METHODS This was a retrospective cohort study among youth seen in a US academic-based weight management clinic from 2012 to 2020. Baseline characteristics (e.g., body mass index (BMI), liver transaminases, eating-related behaviours) and outcomes (%BMI of 95th percentile (%BMIp95), BMI, %BMI change, weight) were determined through electronic health records and intake surveys. RESULTS Among 91 youth prescribed phentermine plus LSM over 8 years (mean %BMIp95 150%), %BMIp95 was statistically significantly reduced at 1.5, 3, 6 and 12 months (peak reduction 10.9 percentage points at 6 months; p < 0.001). Considering multiple comparisons, the presence of baseline elevated alanine aminotransferase was associated with statistically significant smaller 1.5-month %BMIp95 reductions (p = 0.001) and higher food responsiveness with smaller 3- (p = 0.001) and 6-month (p < 0.001) reductions. CONCLUSIONS Phentermine plus LSM reduced %BMIp95 among youth in a weight management clinic, and baseline characteristics may help determine those more or less likely to respond. Prospective studies are needed to further characterize effectiveness and confirm response predictors.
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Affiliation(s)
- Eric M Bomberg
- Center for Pediatric Obesity Medicine, Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, Minnesota, USA
- Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, Minnesota, USA
| | - Justin Clark
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Kyle D Rudser
- Center for Pediatric Obesity Medicine, Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, Minnesota, USA
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Amy C Gross
- Center for Pediatric Obesity Medicine, Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, Minnesota, USA
- Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, Minnesota, USA
| | - Aaron S Kelly
- Center for Pediatric Obesity Medicine, Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, Minnesota, USA
- Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, Minnesota, USA
| | - Claudia K Fox
- Center for Pediatric Obesity Medicine, Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, Minnesota, USA
- Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, Minnesota, USA
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3
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Henderson K, Lewis, Sloan CE, Bessesen DH, Arterburn D. Effectiveness and safety of drugs for obesity. BMJ 2024; 384:e072686. [PMID: 38527759 DOI: 10.1136/bmj-2022-072686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
Recent publicity around the use of new antiobesity medications (AOMs) has focused the attention of patients and healthcare providers on the role of pharmacotherapy in the treatment of obesity. Newer drug treatments have shown greater efficacy and safety compared with older drug treatments, yet access to these drug treatments is limited by providers' discomfort in prescribing, bias, and stigma around obesity, as well as by the lack of insurance coverage. Now more than ever, healthcare providers must be able to discuss the risks and benefits of the full range of antiobesity medications available to patients, and to incorporate both guideline based advice and emerging real world clinical evidence into daily clinical practice. The tremendous variability in response to antiobesity medications means that clinicians need to use a flexible approach that takes advantage of specific features of the antiobesity medication selected to provide the best option for individual patients. Future research is needed on how best to use available drug treatments in real world practice settings, the potential role of combination therapies, and the cost effectiveness of antiobesity medications. Several new drug treatments are being evaluated in ongoing clinical trials, suggesting that the future for pharmacotherapy of obesity is bright.
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Affiliation(s)
| | - Lewis
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Caroline E Sloan
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Margolis Center for Health Policy, Duke University, Durham, NC, USA
| | - Daniel H Bessesen
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado School of Medicine, Aurora, CO, USA
| | - David Arterburn
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
- Division of General Internal Medicine, University of Washington, Seattle, WA, USA
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Hung A, Wong ES, Dennis PA, Stechuchak KM, Blalock DV, Smith VA, Hoerster K, Vimalananda VG, Raffa SD, Maciejewski ML. Real World Use of Anti-Obesity Medications and Weight Change in Veterans. J Gen Intern Med 2024; 39:519-528. [PMID: 37962730 PMCID: PMC10973309 DOI: 10.1007/s11606-023-08501-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 10/20/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Anti-obesity medications (AOMs) can be initiated in conjunction with participation in the VA national behavioral weight management program, MOVE!, to help achieve clinically meaningful weight loss. OBJECTIVE To compare weight change between Veterans who used AOM + MOVE! versus MOVE! alone and examine AOM use, duration, and characteristics associated with longer duration of use. DESIGN Retrospective cohort study using VA electronic health records. PARTICIPANTS Veterans with overweight or obesity who participated in MOVE! from 2008-2017. MAIN MEASURES Weight change from baseline was estimated using marginal structural models up to 24 months after MOVE! initiation. The probability of longer duration of AOM use (≥ 180 days) was estimated via a generalized linear mixed model. RESULTS Among MOVE! participants, 8,517 (1.6%) used an AOM within 24 months after MOVE! initiation with a median of 90 days of cumulative supply. AOM + MOVE! users achieved greater weight loss than MOVE! alone users at 6 (3.2% vs. 1.6%, p < 0.001), 12 (3.4% vs. 1.4%, p < 0.001), and 24 months (2.7% vs. 1.5%, p < 0.001), and had a greater probability of achieving ≥ 5% weight loss at 6 (38.8% vs. 26.0%, p < 0.001), 12 (43.1% vs. 28.4%, p < 0.001), and 24 months (40.4% vs. 33.3%, p < 0.001). Veterans were more likely to have ≥ 180 days of supply if they were older, exempt from medication copays, used other medications with significant weight-gain, significant weight-loss, or modest weight-loss side effects, or resided in the West North Central or Pacific regions. Veterans were less likely to have ≥ 180 days of AOM supply if they had diabetes or initiated MOVE! later in the study period. CONCLUSIONS AOM use following MOVE! initiation was uncommon, and exposure was time-limited. AOM + MOVE! was associated with a higher probability of achieving clinically significant weight loss than MOVE! alone.
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Affiliation(s)
- Anna Hung
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, USA.
- Department of Population Health Sciences, Duke University, Durham, NC, USA.
- Duke-Margolis Center for Health Policy, Durham, NC, USA.
| | - Edwin S Wong
- Seattle-Denver COIN, Seattle, WA, USA
- Department of Health Systems and Population Health, University of Washington School of Medicine, Seattle, WA, USA
| | - Paul A Dennis
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - Karen M Stechuchak
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Dan V Blalock
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Valerie A Smith
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Population Health Sciences, Duke University, Durham, NC, USA
- Division of General Internal Medicine, Department of Medicine, Duke University, Durham, NC, USA
| | - Katherine Hoerster
- Seattle-Denver COIN, Seattle, WA, USA
- Department of Health Systems and Population Health, University of Washington School of Medicine, Seattle, WA, USA
| | - Varsha G Vimalananda
- Center for Healthcare Organization and Implementation Research, VA Bedford Medical Center, Bedford, MA, USA
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Susan D Raffa
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
- National Center for Health Promotion and Disease Prevention, Veterans Health Administration, Durham, NC, USA
| | - Matthew L Maciejewski
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Population Health Sciences, Duke University, Durham, NC, USA
- Duke-Margolis Center for Health Policy, Durham, NC, USA
- Division of General Internal Medicine, Department of Medicine, Duke University, Durham, NC, USA
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MacEwan JP, Chiu K, Ahmad NN, Sacks N, Shinde S, Poon JL, Kan H. Clinical, economic, and health-related quality of life outcomes in patients with overweight or obesity in the United States: 2016-2018. Obes Sci Pract 2024; 10:e726. [PMID: 38263999 PMCID: PMC10804324 DOI: 10.1002/osp4.726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 11/13/2023] [Accepted: 11/14/2023] [Indexed: 01/25/2024] Open
Abstract
Objectives This study aimed to estimate clinical, economic (including productivity), and health-related quality of life (HRQoL) outcomes and associated individual characteristics among adults with overweight (OW) or obesity in the United States. Methods This study included adult respondents with body mass index (BMI) ≥18.5 kg/m2 in the 2017-2018 National Health and Nutrition Examination Survey (NHANES) and 2016 Medical Expenditure Panel Survey. Respondents were classified according to BMI. Individual characteristics were described by BMI categories. Multivariable regression models estimated the association between BMI categories and outcomes, adjusting for individual characteristics. Results Nearly three-quarters (73.7%) of NHANES participants were OW or obese. Relative to Normal weight (NW), respondents with Class 3 obesity had more obesity-related complications (2.07 vs. 4.62, p < 0.001). Higher BMI was associated with significantly lower HRQoL, lower productivity, and higher healthcare expenditures as well as more frequent weight loss attempts in the previous 12 months. Weight loss surgery and prescription anti-obesity medications (AOMs) were used only by a very small proportion of individuals. Despite frequent weight loss attempts, most respondents did not achieve clinically meaningful weight loss. Conclusions Adults with OW or obesity experienced worse clinical, economic and HRQoL outcomes than those with NW. Better use of evidence-based obesity treatments, including prescription AOMs, should be considered to achieve more clinically meaningful weight reduction and improved outcomes in individuals with OW or obesity.
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Affiliation(s)
| | - Kevin Chiu
- Santa Clara UniversitySanta ClaraCaliforniaUSA
| | | | | | | | | | - Hong Kan
- Eli Lilly & CompanyIndianapolisIndianaUSA
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Gravina D, Keeler JL, Akkese MN, Bektas S, Fina P, Tweed C, Willmund GD, Treasure J, Himmerich H. Randomized Controlled Trials to Treat Obesity in Military Populations: A Systematic Review and Meta-Analysis. Nutrients 2023; 15:4778. [PMID: 38004172 PMCID: PMC10674729 DOI: 10.3390/nu15224778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 11/03/2023] [Accepted: 11/05/2023] [Indexed: 11/26/2023] Open
Abstract
In recent years, overweight and obesity have reached an alarmingly high incidence and prevalence worldwide; they have also been steadily increasing in military populations. Military personnel, as an occupational group, are often exposed to stressful and harmful environments that represent a risk factor for disordered eating, with major repercussions on both physical and mental health. This study aims to explore the effectiveness of weight loss interventions and assess the significance of current obesity treatments for these populations. Three online databases (PubMed, PsycInfo, and Web of Science) were screened to identify randomized controlled trials (RCTs) aiming to treat obesity in active-duty military personnel and veterans. Random-effects meta-analyses were conducted for body weight (BW) and body mass index (BMI) values, both longitudinally comparing treatment groups from pre-to-post intervention and cross-sectionally comparing the treatment group to controls at the end of the intervention. A total of 21 studies were included: 16 cross-sectional (BW: n = 15; BMI: n = 12) and 16 longitudinal (BW: n = 15; BMI: n = 12) studies were meta-analyzed, and 5 studies were narratively synthesized. A significant small overall BW and BMI reduction from baseline to post-intervention was observed (BW: g = -0.10; p = 0.015; BMI: g = -0.32; p < 0.001), together with a decreased BMI (g = -0.16; p = 0.001) and nominally lower BW (g = -0.08; p = 0.178) in the intervention group compared to controls at the post-intervention time-point. Despite limitations, such as the heterogeneity across the included interventions and the follow-up duration, our findings highlight how current weight loss interventions are effective in terms of BW and BMI reductions in military populations and how a comprehensive approach with multiple therapeutic goals should be taken during the intervention.
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Affiliation(s)
- Davide Gravina
- Centre for Research in Eating and Weight Disorders, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London SE5 8AF, UK; (J.L.K.); (M.N.A.); (S.B.); (J.T.); (H.H.)
- Department of Clinical and Experimental Medicine, University of Pisa, 56127 Pisa, Italy
| | - Johanna Louise Keeler
- Centre for Research in Eating and Weight Disorders, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London SE5 8AF, UK; (J.L.K.); (M.N.A.); (S.B.); (J.T.); (H.H.)
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham BR3 3BX, UK;
| | - Melahat Nur Akkese
- Centre for Research in Eating and Weight Disorders, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London SE5 8AF, UK; (J.L.K.); (M.N.A.); (S.B.); (J.T.); (H.H.)
| | - Sevgi Bektas
- Centre for Research in Eating and Weight Disorders, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London SE5 8AF, UK; (J.L.K.); (M.N.A.); (S.B.); (J.T.); (H.H.)
- Department of Psychology, Hacettepe University, Ankara 06800, Türkiye
| | - Paula Fina
- Faculty of Psychology, Sigmund Freud University Vienna, Freudplatz 1, 1020 Vienna, Austria;
| | - Charles Tweed
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham BR3 3BX, UK;
- Royal Navy Reserve, London WC1N 1NP, UK
| | - Gerd-Dieter Willmund
- Bundeswehr Center for Military Mental Health, Military Hospital Berlin, 13, 10115 Berlin, Germany;
| | - Janet Treasure
- Centre for Research in Eating and Weight Disorders, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London SE5 8AF, UK; (J.L.K.); (M.N.A.); (S.B.); (J.T.); (H.H.)
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham BR3 3BX, UK;
| | - Hubertus Himmerich
- Centre for Research in Eating and Weight Disorders, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London SE5 8AF, UK; (J.L.K.); (M.N.A.); (S.B.); (J.T.); (H.H.)
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham BR3 3BX, UK;
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Garvey WT, Cheng M, Ramasamy A, Smolarz BG, Park S, Kumar N, Kim N, DerSarkissian M, Bhak RH, Duh MS, Wu M, Hansen S, Young-Xu Y. Clinical and Cost Benefits of Anti-Obesity Medication for US Veterans Participating in the MOVE! Weight Management Program. Popul Health Manag 2023; 26:72-82. [PMID: 36735596 DOI: 10.1089/pop.2022.0227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Abstract This study investigated the clinical and economic impact of anti-obesity medications (AOMs; orlistat, liraglutide, phentermine/topiramate extended-release [ER], naltrexone ER/bupropion ER) among United States Veterans with obesity participating in Motivating Overweight/Obese Veterans Everywhere! (MOVE!), a government-initiated weight management program. The study population was identified from electronic medical records of the Veterans Health Administration (2010-2020). Clinical indices of obesity and health care resource utilization and costs were evaluated at 6, 12, and 24 months after the initial dispensing of an AOM in the AOM+MOVE! cohort (N = 3732, mean age 57 years, 79% male) or on the corresponding date of an inpatient or outpatient encounter in the MOVE! cohort (N = 7883, mean age 58 years, 81% male). At 6 months postindex, the AOM+MOVE! cohort had better cardiometabolic indices (eg, systolic blood pressure, diastolic blood pressure, total cholesterol, low-density lipoprotein cholesterol, hemoglobin A1c) than the MOVE! cohort, with the trends persisting at 12 and 24 months. The AOM+MOVE! cohort was significantly more likely than the MOVE! cohort to have weight decreases of 5%-10%, 10%-15%, and >15% and lower body mass index at 6, 12, and 24 months. The AOM+MOVE! cohort also had fewer inpatient and emergency department visits than the MOVE! cohort, which was associated with lower mean total medical costs including inpatient costs. These results suggest that combining AOM treatment with the MOVE! program could yield long-term cost savings for the Veterans Affairs network and meaningful clinical improvements for Veterans with obesity.
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Affiliation(s)
- W Timothy Garvey
- UAB Diabetes Research Center, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Mu Cheng
- Analysis Group, Inc., Boston, Massachusetts, USA
| | | | | | - Suna Park
- Analysis Group, Inc., Boston, Massachusetts, USA
| | - Neela Kumar
- Novo Nordisk, Inc., Plainsboro, New Jersey, USA
| | - Nina Kim
- Novo Nordisk, Inc., Plainsboro, New Jersey, USA
| | | | | | | | - Melody Wu
- Analysis Group, Inc., Boston, Massachusetts, USA
| | | | - Yinong Young-Xu
- Clinical Epidemiology Program, White River Junction Veterans Affairs Medical Center, White River Junction, Vermont, USA
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Din N, Fan J, Schmitt S, Guo JD, Hlavacek P, Pundi K, Russ C, Emir B, Turakhia MP, Perino AC. Warfarin Time in Therapeutic INR Range and Direct Oral Anticoagulant Adherence for Venous Thromboembolism Across the Spectrum of Weight and Body Mass Index: Findings from Veterans Health Administration. Clin Appl Thromb Hemost 2023; 29:10760296231152474. [PMID: 36694957 PMCID: PMC9893071 DOI: 10.1177/10760296231152474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
The evidence of direct oral anticoagulants (DOACs) usage for venous thromboembolism (VTE) in patients at extremes of body weight or mass index is limited. In such situations, warfarin may be more frequently used. We investigated warfarin time in the therapeutic international normalized ratio range (TTR) and DOAC adherence based on the calculated proportion of days covered (PDC) by pill coverage from a DOAC prescription in patients with VTE across all body sizes. Using data from the Veterans Health Administration (VA), we identified first-time patients with VTE between 2013 and 2018 treated with warfarin or DOACs. We analyzed 28,245 patients with warfarin TTR (N = 10,167) or DOAC PDC(N = 18,078). For warfarin-treated patients after index VTE, mean TTR was lower over shorter treatment durations (TTR 30 vs TTR 180 [mean ± SD]: 43.8% ± 33.5% vs 58.8% ± 23.5%). Mean TTR over 180 days after VTE was lowest for patients <60 kg (TTR 180 [mean ± SD]: <60kg: 49.3% ± 24.2% vs ≥60 to <100 kg: 57.8% ± 23.4%; P < .0001). For DOAC-treated patients over 180 days after index VTE, mean PDC was lowest for patients <60 kg (PDC 180 [mean ± SD]: < 60kg: 76.9% ± 33.2% vs ≥ 60 to <100 kg: 83.6% ± 27.7%; P < .0001).Most DOAC-treated patients attained sufficient adherence across the body size spectrum while warfarin-treated patients <60kg were at risk for low TTR.
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Affiliation(s)
- Natasha Din
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA,Center for Digital Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Jun Fan
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Susan Schmitt
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Jennifer D. Guo
- Bristol Myers Squibb, Lawrenceville, NJ, USA former employee at the time the study was conducted
| | | | - Krishna Pundi
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | | | | | - Mintu P. Turakhia
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA,Center for Digital Health, Stanford University School of Medicine, Stanford, CA, USA,Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Alexander C. Perino
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA,Center for Digital Health, Stanford University School of Medicine, Stanford, CA, USA,Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA,Alexander C. Perino, Center for Academic Medicine, Department of Medicine/Division of Cardiovascular Medicine, Mail Code 5687, Stanford University School of Medicine, 453 Quarry Road, Palo Alto, CA 94304, USA.
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9
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Prevalence of Antiobesity Treatment and Weight-Inducing Antihyperglycemic Agents Among Patients With Type 2 Diabetes in the United States. Clin Ther 2022; 44:e35-e44. [DOI: 10.1016/j.clinthera.2022.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/30/2021] [Accepted: 01/06/2022] [Indexed: 11/19/2022]
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10
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Perino AC, Fan J, Schmitt S, Guo JD, Hlavacek P, Din N, Kothari M, Pundi K, Russ C, Emir B, Turakhia MP. Anticoagulation Treatment and Outcomes of Venous Thromboembolism by Weight and Body Mass Index: Insights From the Veterans Health Administration. Circ Cardiovasc Qual Outcomes 2021; 14:e008005. [PMID: 34724801 DOI: 10.1161/circoutcomes.121.008005] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Consensus statements have recommended against the use of direct oral anticoagulants (DOACs) in venous thromboembolism (VTE) for patients ≥120 kg and ≥40 kg/m2. We sought to determine use and outcomes of DOACs for VTE across weight and body mass index (BMI). METHODS We performed a retrospective cohort study of patients with first-time VTE 2013 to 2018 that were treated with DOAC or warfarin in the Veterans Health Administration. The Veterans Health Administration has implemented system-wide guidance for patient selection and shared decision-making for use of DOACs in VTE at extremes of weight. We stratified patients by weight and BMI and assessed (1) association of weight and BMI category to outcomes in those prescribed DOAC; and (2) association of DOAC, as compared to warfarin, to outcomes by weight and BMI categories. Outcomes of interest included major bleeding, clinically relevant nonmajor bleeding, and recurrent VTE. RESULTS The analysis cohort included 51 871 patients prescribed DOAC or warfarin within 30 days of index VTE diagnosis (age 64.5±13.1 years; 6.0% female; median weight 93.4 kg [25th-75th: 80.5-108.6 kg]). For patients ≥120 kg (N=6934 patients), 38.4% were treated with DOAC, as compared to 45.4% of those ≥60 to <100 kg (N=30 645; P<0.0001). DOAC prescription was not associated with major bleeds, clinically relevant nonmajor bleeds, or recurrent VTE for those in higher weight and BMI categories as compared to those in average weight and BMI categories. DOAC prescription, as compared to warfarin, was not associated with increased recurrent VTE in any weight or BMI category. CONCLUSIONS Patients ≥120 kg and ≥40 kg/m2 with VTE are frequently prescribed DOAC by the Veterans Health Administration, without an increase in bleeding or recurrent VTE. These findings suggest DOACs can be safe and effective in this population and may argue for broader adoption of pharmacy policies that promote careful patient selection and shared decision making.
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Affiliation(s)
- Alexander C Perino
- Department of Medicine (A.C.P., K.P., M.P.T.) and Center for Digital Health (A.C.P., N.D., M.P.T.), Stanford University School of Medicine, CA
- Veterans Affairs Palo Alto Health Care System, CA (A.C.P., J.F., S.S., N.D., M.K., M.P.T.)
| | - Jun Fan
- Veterans Affairs Palo Alto Health Care System, CA (A.C.P., J.F., S.S., N.D., M.K., M.P.T.)
| | - Susan Schmitt
- Veterans Affairs Palo Alto Health Care System, CA (A.C.P., J.F., S.S., N.D., M.K., M.P.T.)
| | | | | | - Natasha Din
- Veterans Affairs Palo Alto Health Care System, CA (A.C.P., J.F., S.S., N.D., M.K., M.P.T.)
| | - Mitra Kothari
- Veterans Affairs Palo Alto Health Care System, CA (A.C.P., J.F., S.S., N.D., M.K., M.P.T.)
| | - Krishna Pundi
- Department of Medicine (A.C.P., K.P., M.P.T.) and Center for Digital Health (A.C.P., N.D., M.P.T.), Stanford University School of Medicine, CA
| | | | | | - Mintu P Turakhia
- Department of Medicine (A.C.P., K.P., M.P.T.) and Center for Digital Health (A.C.P., N.D., M.P.T.), Stanford University School of Medicine, CA
- Veterans Affairs Palo Alto Health Care System, CA (A.C.P., J.F., S.S., N.D., M.K., M.P.T.)
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11
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MacEwan J, Kan H, Chiu K, Poon JL, Shinde S, Ahmad NN. Anti-obesity Medication Use Among Adults with Overweight and Obesity in the United States: 2015-2018. Endocr Pract 2021; 27:1139-1148. [PMID: 34265455 DOI: 10.1016/j.eprac.2021.07.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/01/2021] [Accepted: 07/03/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To estimate utilization of FDA-approved prescription anti-obesity medications (AOMs) and identify factors associated with AOM use in the United States. METHODS Respondents >18 years-old meeting AOM eligibility criteria in 2015-2016 and 2017-2018 National Health and Nutrition Examination Survey (NHANES) and 2016 Medical Expenditure Panel Survey (MEPS) were included in the study. AOM eligibility was defined as having a body mass index (BMI) >30 kg/m2, or a BMI between 27 to 29.9 kg/m2 and at least one obesity-related comorbidity. Demographic, socioeconomic, and clinical characteristics, economic outcomes and health-related quality of life were summarized and compared between AOM users and non-users. Multivariable logistic regression was used to identify factors associated with AOM use. RESULTS Only 0.80% of eligible adults reported use of AOMs in the past 30 days in 2015-2016 and 2017-2018 NHANES. A greater proportion of current AOM users previously tried dietary changes compared to non-users. They also reported an average weight loss of 6.8 lbs. (3.1 kg) over the previous year compared to a 3.3 lbs. (1.5 kg) gain among non-users. Total healthcare costs trended higher among AOM users, driven mostly by higher outpatient healthcare costs. A BMI ≥30 kg/m2, depression, dyslipidemia, and infertility predicted AOM use, whereas Medicare and being at risk of sleep apnea were associated with lower odds of AOM use. CONCLUSION Despite availability of newer AOMs and inclusion of AOMs in medical treatment guidelines, AOM utilization remains low. This may reflect under-prescribing of and/or restricted patient access to approved evidence-based pharmacotherapy for obesity.
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Affiliation(s)
- Joanna MacEwan
- PRECISIONheor, Los Angeles, CA; Genesis Research, Hoboken, NJ.
| | - Hong Kan
- Eli Lilly & Company, Indianapolis, IN
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12
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Mingrone G, Bornstein SR. Gain in survival after metabolic-bariatric surgery. Lancet 2021; 397:1785-1787. [PMID: 33965072 DOI: 10.1016/s0140-6736(21)00952-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 04/21/2021] [Indexed: 01/03/2023]
Affiliation(s)
- Geltrude Mingrone
- Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome 00168, Italy; Division of Diabetes & Nutritional Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK.
| | - Stefan R Bornstein
- Division of Diabetes & Nutritional Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK; Department of Medicine III, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany
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13
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Squadrito F, Rottura M, Irrera N, Minutoli L, Bitto A, Barbieri MA, Cicala G, Mecchio A, Pallio G, Marino S, Picciolo G, Altavilla D, Arcoraci V. Anti-obesity drug therapy in clinical practice: Evidence of a poor prescriptive attitude. Biomed Pharmacother 2020; 128:110320. [PMID: 32502842 DOI: 10.1016/j.biopha.2020.110320] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/19/2020] [Accepted: 05/23/2020] [Indexed: 01/01/2023] Open
Abstract
Obesity is a worldwide growing problem for the health care systems and its treatment is strongly recommended. Orlistat, naltrexone/bupropion, and liraglutide are approved for weight loss in Italy in patients with a Body Mass Index (BMI) ≥ 30 kg/m2 or ≥ 27 kg/m2 with concomitant diseases. However, the prescription of these drugs is significantly low worldwide. General practitioners (GPs) play a key role in the early diagnosis and appropriate management of obesity. The aim of the study was to investigate the management of obesity and the prescriptive attitude of anti-obesity drugs in a general practice setting. All patients registered in lists of 8 GPs with a recorded diagnosis of obesity or BMI values ≥ 30 kg/m2 in the period 2017-2018, were recruited. A descriptive analysis of demographic and clinical characteristic was carried out. The Spearman's correlation rank test was applied to identify correlations between BMI and all the variables of interest. Among 1301 obese patients, only 66.1 % had been diagnosed and 29.4 % had no registered BMI value. Patients with recorded BMI, were overweight (7.8 %) or in the obesity class I (38.8 %), class II (14.1 %), and class III (7.1 %), respectively. The obese patients (class 1-3) were older [66 (55-76) vs 49 (32-59); p < 0.01], and had more concurrent diseases [5 (3-8) vs 4 (2-6); p < 0.01] than patients who reached a BMI < 30 Kg/m2. Moreover, most of obese were high cardiovascular risk (HCVr) patients (67.0 % vs 31.9 %; p < 0.01). The BMI was directly related to age (rs 0.14; p < 0.01), diabetes (rs 0.19; p < 0.01), hypertension (rs 0.14; p < 0.01), heart failure (rs 0.09; p < 0.01), HCVr (rs 0. 12; p < 0.01) and number of comorbidities (rs 0.08; p = 0.01). No prescriptions of orlistat or naltrexone/bupropion were found. Liraglutide was prescribed only in 7 patients because of the concomitant presence of diabetes. Our results suggest a low adherence to guide line recommendations for obesity management and confirm an under-prescription of anti-obesity drugs in Italy.
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Affiliation(s)
- Francesco Squadrito
- Department of Clinical and Experimental Medicine, University of Messina, c/o AOU Policlinico G. Martino, Via C. Valeria Gazzi, 98125, Messina, Italy.
| | - Michelangelo Rottura
- Department of Clinical and Experimental Medicine, University of Messina, c/o AOU Policlinico G. Martino, Via C. Valeria Gazzi, 98125, Messina, Italy
| | - Natasha Irrera
- Department of Clinical and Experimental Medicine, University of Messina, c/o AOU Policlinico G. Martino, Via C. Valeria Gazzi, 98125, Messina, Italy
| | - Letteria Minutoli
- Department of Clinical and Experimental Medicine, University of Messina, c/o AOU Policlinico G. Martino, Via C. Valeria Gazzi, 98125, Messina, Italy
| | - Alessandra Bitto
- Department of Clinical and Experimental Medicine, University of Messina, c/o AOU Policlinico G. Martino, Via C. Valeria Gazzi, 98125, Messina, Italy
| | - Maria Antonietta Barbieri
- Department of Clinical and Experimental Medicine, University of Messina, c/o AOU Policlinico G. Martino, Via C. Valeria Gazzi, 98125, Messina, Italy
| | - Giuseppe Cicala
- Department of Clinical and Experimental Medicine, University of Messina, c/o AOU Policlinico G. Martino, Via C. Valeria Gazzi, 98125, Messina, Italy
| | - Anna Mecchio
- Department of Biomedical, Dental, Morphological and Functional Imaging Sciences, University of Messina, c/o AOU Policlinico G. Martino, Via C. Valeria Gazzi, 98125, Messina, Italy
| | - Giovanni Pallio
- Department of Clinical and Experimental Medicine, University of Messina, c/o AOU Policlinico G. Martino, Via C. Valeria Gazzi, 98125, Messina, Italy
| | - Sebastiano Marino
- Department of Clinical and Experimental Medicine, University of Messina, c/o AOU Policlinico G. Martino, Via C. Valeria Gazzi, 98125, Messina, Italy
| | - Giacomo Picciolo
- Department of Biomedical, Dental, Morphological and Functional Imaging Sciences, University of Messina, c/o AOU Policlinico G. Martino, Via C. Valeria Gazzi, 98125, Messina, Italy
| | - Domenica Altavilla
- Department of Biomedical, Dental, Morphological and Functional Imaging Sciences, University of Messina, c/o AOU Policlinico G. Martino, Via C. Valeria Gazzi, 98125, Messina, Italy
| | - Vincenzo Arcoraci
- Department of Clinical and Experimental Medicine, University of Messina, c/o AOU Policlinico G. Martino, Via C. Valeria Gazzi, 98125, Messina, Italy
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14
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Saxon DR, Iwamoto SJ, Mettenbrink CJ, McCormick E, Arterburn D, Daley MF, Oshiro CE, Koebnick C, Horberg M, Young DR, Bessesen DH. Antiobesity Medication Use in 2.2 Million Adults Across Eight Large Health Care Organizations: 2009-2015. Obesity (Silver Spring) 2019; 27:1975-1981. [PMID: 31603630 PMCID: PMC6868321 DOI: 10.1002/oby.22581] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 06/13/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The aim of this study was to examine the prescribing patterns and use of antiobesity medications in a large cohort of patients using data from electronic health records. METHODS Pharmacy- and patient-level electronic health record data were obtained on 2,248,407 adults eligible for weight-loss medications from eight geographically dispersed health care organizations. RESULTS A total of 29,964 patients (1.3% of total cohort) filled at least one weight-loss medication prescription. This cohort was 82.3% female, with median age 44.9 years and median BMI 37.2 kg/m2 . Phentermine accounted for 76.6% of all prescriptions, with 51.7% of prescriptions being filled for ≥ 120 days and 33.8% filled for ≥ 360 days. There was an increase of 32.9% in medication days for all medications in 2015 compared with 2009. Higher prescription rates were observed in women, black patients, and patients in higher BMI classes. Of 3,919 providers who wrote at least one filled prescription, 23.8% (n = 863) were "frequent prescribers" who wrote 89.6% of all filled prescriptions. CONCLUSIONS Weight-loss medications are rarely prescribed to eligible patients. Phentermine accounted for > 75% of all medication days, with a majority of patients filling it for more than 4 months. Less than one-quarter of prescribing providers accounted for approximately 90% of all prescriptions.
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Affiliation(s)
- David R Saxon
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
- Division of Endocrinology, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado, USA
| | - Sean J Iwamoto
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
- Division of Endocrinology, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado, USA
| | | | | | - David Arterburn
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Matthew F Daley
- Kaiser Permanente Colorado Institute for Health Research, Denver, Colorado, USA
| | - Caryn E Oshiro
- Kaiser Permanente Center for Health Research Hawaii, Honolulu, Hawaii, USA
| | - Corinna Koebnick
- Department of Research and Evaluation, Kaiser Permanente, Pasadena, California, USA
| | - Michael Horberg
- Kaiser Permanente Mid-Atlantic Permanente Research Institute, Rockville, Maryland, USA
| | - Deborah R Young
- Kaiser Permanente Mid-Atlantic Permanente Research Institute, Rockville, Maryland, USA
| | - Daniel H Bessesen
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
- Denver Health Medical Center, Denver, Colorado, USA
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15
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Li X, Bello NT. Anorectic state of obesity medications in the United States. Are leaner times ahead? Expert Opin Pharmacother 2019; 21:167-172. [PMID: 31762335 DOI: 10.1080/14656566.2019.1692815] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: Obesity is considered to be a chronic disease. Currently there are five prescription-only medications on the US market for the long-term management of obesity. However, these medications are underutilized by obese or overweight individuals seeking medical assistance for weight management.Areas covered: This special report provides an overview of the emerging obesity pharmacotherapies based on the data available from recruiting and active phase II/III trials from a registry of clinical trials. The authors also give their expert opinion and provide their future perspectives on the treatment of obesity based on what is known.Expert opinion: Despite obesity being a chronic condition affecting 40% of the US population, there is a low demand for obesity medications in the US market. Although the potential obesity medications that are currently being investigated in phase II/III clinical trials are promising, it is unclear whether the future pharmacotherapies will be enough to meet the health care need.
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Affiliation(s)
- Xinyi Li
- Department of Animal Sciences, School of Environmental and Biological Sciences, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA.,Nutritional Sciences Graduate Program, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Nicholas T Bello
- Department of Animal Sciences, School of Environmental and Biological Sciences, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA.,Nutritional Sciences Graduate Program, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA.,New Jersey Institute for Food, Nutrition, and Health, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
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16
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Thomas DD, Waring ME, Ameli O, Reisman JI, Vimalananda VG. Patient Characteristics Associated with Receipt of Prescription Weight-Management Medications Among Veterans Participating in MOVE! Obesity (Silver Spring) 2019; 27:1168-1176. [PMID: 31090207 PMCID: PMC6591039 DOI: 10.1002/oby.22503] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 03/15/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Weight-management medications (WMM) are recommended for the treatment of obesity. This study examined characteristics associated with initial receipt of WMM among eligible veterans in the first year following enrollment in the Veterans Health Administration (VHA) MOVE! behavioral weight-management program. METHODS We conducted a retrospective cohort study of VHA patients with obesity or overweight and obesity-related comorbidities who enrolled in MOVE! from October 2013 to September 2016 (N = 153,939). Multivariable logistic regression models estimated predictors of having a filled prescription for WMM and for orlistat. RESULTS A total of 1.1% of these veterans received WMM. The most common WMM included orlistat (70.4%), phentermine/topiramate (11.2%), and bupropion/naltrexone (9.7%). Female sex, higher BMI, obstructive sleep apnea, osteoarthritis, depression, lower back pain, and alcohol abuse were associated with greater odds of use of WMM, whereas age over 65 years, Hispanic ethnicity, and required co-payments were associated with lower odds. Among patients receiving WMM, older age, black race, female sex, higher BMI, cardiovascular disease, lower back pain, and congestive heart failure were associated with use of orlistat versus any other WMM. CONCLUSIONS Of patients engaged in MOVE! in the VHA, 1.1% received WMM. WMM are underutilized among veterans. Additional research is needed to understand barriers to incorporating WMM into comprehensive obesity treatment plans.
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Affiliation(s)
- Dylan D. Thomas
- Section of Endocrinology, Diabetes, Nutrition, and Weight Management, Department of Medicine; Boston University School of Medicine. Boston, MA
| | - Molly E. Waring
- Department of Allied Health Sciences, University of Connecticut. Storrs, CT
| | - Omid Ameli
- Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Affairs Medical Center. Bedford, MA
| | - Joel I. Reisman
- Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Affairs Medical Center. Bedford, MA
| | - Varsha G. Vimalananda
- Section of Endocrinology, Diabetes, Nutrition, and Weight Management, Department of Medicine; Boston University School of Medicine. Boston, MA
- Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Affairs Medical Center. Bedford, MA
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17
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Iwamoto S, Saxon D, Tsai A, Leister E, Speer R, Heyn H, Kealey E, Juarez-Colunga E, Gudzune K, Bleich S, Clark J, Bessesen D. Effects of Education and Experience on Primary Care Providers' Perspectives of Obesity Treatments during a Pragmatic Trial. Obesity (Silver Spring) 2018; 26:1532-1538. [PMID: 30257072 PMCID: PMC6168402 DOI: 10.1002/oby.22223] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 05/08/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To examine the impact of a 1-year pragmatic obesity trial on primary care providers' (PCPs) perspectives of treatment. METHODS PCPs from four intervention clinics (PCP-I) and five control clinics (PCP-C) completed pre- and postintervention surveys on weight-loss counseling, comfort discussing obesity treatments, and perceived effectiveness of interventions; questions were rated on 0 to 10 Likert scales. Only PCP-I received patient updates and education about obesity management. RESULTS Eighty PCPs completed preintervention surveys (pre: 71% female, 71% physicians); 82 PCPs completed postintervention surveys (post: 66% female, 70% physicians). PCPs were most comfortable discussing exercise before and after the trial (pre PCP-C: 8.22 [1.44], mean [standard deviation (SD)]; post PCP-C: 8.37 [1.24]; P = 0.8; pre/post PCP-I: 7.88 [1.51] vs. 7.80 [1.71]; P = 0.3). PCPs were initially least comfortable discussing phentermine/topiramate extended release (ER) but developed significantly more comfort after the trial, to a greater degree among PCP-I (pre/post PCP-C: 2.86 [2.66] vs. 3.73 [2.72], P < 0.001; pre/post PCP-I: 4.00 [2.57] vs. 6.17 [2.27], P < 0.001). After the trial, both PCPs rated exercise significantly less effective for weight loss, with a greater decrease in effectiveness rations among PCP-I (pre/post PCP-C: 7.73 [1.94] vs. 6.93 [2.35], P = 0.017; pre/post PCP-I: 6.27 [2.69] vs. 5.15 [2.31], P = 0.001). Both PCPs rated phentermine (pre/post PCP-C: 5.03 [2.05] vs. 5.50 [2.12], P = 0.002; pre/post PCP-I: 5.70 [1.64] vs. 6.83 [1.18], P = 0.001) and phentermine/topiramate ER (pre/post PCP-C: 3.91 [2.33] vs. 5.47 [2.54], P < 0.001; pre/post PCP-I: 5.58 [2.21] vs. 7.02 [1.47], P < 0.001) significantly more effective after the trial, though ratings were higher among PCP-I. CONCLUSIONS PCPs initially overvalued exercise and undervalued weight-loss medications. PCPs exposed to education and experience gave higher comfort and effectiveness ratings to weight-loss medications.
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Affiliation(s)
- Sean Iwamoto
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
- Department of Endocrinology, Veterans Affairs Eastern Colorado Health Care System, Denver, CO, USA
| | - David Saxon
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
- Denver/Seattle Center of Innovation for Veteran-Centered and Values Driven Care, Department of Endocrinology, Veterans Affairs Eastern Colorado Health Care System, Denver, CO, USA
| | - Adam Tsai
- Department of Internal Medicine and Metabolic-Surgical Weight Management, Kaiser Permanente Colorado, Denver, CO, USA
| | - Erin Leister
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, USA
- Adult and Child Consortium for Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine, Aurora, CO, USA
| | - Rebecca Speer
- Department of Medicine, Section of Endocrinology, Denver Health Medical Center, Denver, CO, USA
| | - Hilde Heyn
- Department of Medicine, Section of Endocrinology, Denver Health Medical Center, Denver, CO, USA
| | - Elizabeth Kealey
- Anschutz Health and Wellness Center, University of Colorado at Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Elizabeth Juarez-Colunga
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, USA
- Adult and Child Consortium for Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine, Aurora, CO, USA
| | - Kimberly Gudzune
- Department of Medicine, Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, The Johns Hopkins University, Baltimore, MD, USA
| | - Sara Bleich
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jeanne Clark
- Department of Medicine, Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, The Johns Hopkins University, Baltimore, MD, USA
| | - Daniel Bessesen
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
- Department of Medicine, Section of Endocrinology, Denver Health Medical Center, Denver, CO, USA
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18
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Maciejewski ML, Shepherd-Banigan M, Raffa SD, Weidenbacher HJ. Systematic Review of Behavioral Weight Management Program MOVE! for Veterans. Am J Prev Med 2018; 54:704-714. [PMID: 29550164 DOI: 10.1016/j.amepre.2018.01.029] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 01/09/2018] [Accepted: 01/29/2018] [Indexed: 12/22/2022]
Abstract
CONTEXT Since 2006, the Veterans Health Administration has delivered a population-based behavioral weight management program (MOVE!) to Veterans, which numerous studies have examined. The purpose of this study was to systematically review these studies to understand MOVE! participation rates and the association between MOVE! participation and weight change. EVIDENCE ACQUISITION A December 2016 PubMed search identified 320 English-language abstracts published between January 1, 2005 and December 31, 2016, of which 42 underwent full-text review. Twenty-six articles were determined to be eligible for final inclusion and data elements extracted from these articles included study years, study design, content of MOVE! and control intervention (if any), inclusion/exclusion criteria, initial sample size and sample loss, intervention duration and follow-up, patient characteristics, and outcomes. Quality was assessed using the Newcastle-Ottawa Quality Scale. EVIDENCE SYNTHESIS Studies were judged to be of good quality. Twenty-one of the 26 studies were retrospective cohort studies, one was a prospective cohort study and four were randomized trials. Program participation varied substantially (2%-12%) across studies. Six-month weight loss ranged from -0.95 kg to -1.84 kg, whereas 12-month weight loss ranged from -0.13 kg to -3.3 kg. A maximum of 25% of MOVE! users engaged in intense and sustained participation (eight or more visits within 6 months), but higher participation levels were consistently associated with greater weight change (-1.18 kg to -5.3 kg at 6 months, -1.68 kg to -3.58 kg at 12 months). CONCLUSIONS MOVE! participation is associated with modest short-term weight loss, with greater weight loss as participation increases. More research is needed to understand the barriers and facilitators to participation and the effect of MOVE! participation on long-term health and economic outcomes.
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Affiliation(s)
- Matthew L Maciejewski
- Center for Health Services Research in Primary Care, Durham Department of Veterans Affairs Medical Center, Durham, North Carolina; Department of Population Health Sciences, Duke University Medical Center, Durham, North Carolina.
| | - Megan Shepherd-Banigan
- Center for Health Services Research in Primary Care, Durham Department of Veterans Affairs Medical Center, Durham, North Carolina
| | - Susan D Raffa
- Veterans Health Administration National Center for Health Promotion and Disease Prevention, Durham, North Carolina
| | - Hollis J Weidenbacher
- Center for Health Services Research in Primary Care, Durham Department of Veterans Affairs Medical Center, Durham, North Carolina
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19
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Simon R, Lahiri SW. PROVIDER PRACTICE HABITS AND BARRIERS TO CARE IN OBESITY MANAGEMENT IN A LARGE MULTICENTER HEALTH SYSTEM. Endocr Pract 2018; 24:321-328. [PMID: 29561192 DOI: 10.4158/ep-2017-0221] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To identify provider recommendations and barriers in obesity management in a multicenter academic health system with extensive weight-loss management resources. METHODS A 26-question online survey was sent to attending physicians, trainees, and advanced practice providers in primary care specialties (internal medicine, family medicine, women's health) and endocrinology. RESULTS The survey response rate was 26% (111/430). Of respondents, 50% were internal medicine, 24% family medicine, 16% women's health, and 9% endocrinology. The majority were attending physicians (54%) and residents (40%). About 50% of respondents advised weight loss for a body mass index (BMI) >30 kg/m2 in >50% of clinic visits. Limited time (82%) was the most common reason for not discussing weight loss, followed by the perception that discussion would not change patient behavior, insufficient knowledge, and discomfort broaching the subject. Common barriers to prescribing anti-obesity medications included limited experience (57%) and concern for adverse reactions (26%). Only 44% offered bariatric surgery to >50% of their patients who met criteria. Primary reasons for not referring included concerns of high surgical risk from comorbidities (57%) and potential adverse events (32%). Endocrinology had the highest referral to surgery. Attending physicians and fellows were more likely than residents to advise weight loss at lower BMI, offer medications, and refer to bariatric surgery. CONCLUSION Our study reveals reluctance and lack of primary care confidence in managing obesity with pharmacotherapy and bariatric surgery, especially in the earlier stages of obesity. Barriers to care include lack of clinic time, limited experience, and concerns about treatment risks. ABBREVIATIONS BMI = body mass index; HbA1c = hemoglobin A1c; IRB = Institutional Review Board.
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Bessesen DH, Van Gaal LF. Progress and challenges in anti-obesity pharmacotherapy. Lancet Diabetes Endocrinol 2018; 6:237-248. [PMID: 28919062 DOI: 10.1016/s2213-8587(17)30236-x] [Citation(s) in RCA: 199] [Impact Index Per Article: 33.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 06/20/2017] [Accepted: 06/27/2017] [Indexed: 01/02/2023]
Abstract
Obesity is a serious and growing worldwide health challenge. Healthy lifestyle choices are the foundation of obesity treatment. However, weight loss can lead to physiological adaptations that promote weight regain. As a result, lifestyle treatment alone typically produces only modest weight loss that is difficult to sustain. In other metabolic diseases, pharmacotherapy is an accepted adjunct to lifestyle. Several anti-obesity drugs have been approved in the USA, European Union, Australia, and Japan including sympathomimetics, pancreatic lipase inhibitors, GABAA receptor activators, a serotonin 2C receptor agonist, opioid antagonist, dopamine-norepinephrine reuptake inhibitor, and glucagon-like peptide-1 (GLP-1) receptor agonists. These drugs vary in their efficacy and side-effect profiles but all provide greater weight loss than do lifestyle changes alone. Even though obesity is widespread and associated with adverse health consequences, and anti-obesity drugs can help people to lose weight, very few patients use these drugs partly because of concerns about safety and efficacy, but also because of inadequate health insurance coverage. Despite great advances in our understanding of the biology of weight regulation, many clinicians still believe that patients with obesity should have the willpower to eat less. The tendency to hold the patient with obesity responsible for their condition can be a barrier to greater acceptance of anti-obesity drugs as appropriate options for treatment. Physicians should be comfortable discussing the risks and benefits of these drugs, and health insurance companies should provide reasonable coverage for their use in patients who are most likely to benefit. Although few promising anti-obesity medications are in the drug-development pipeline, the most promising drugs are novel molecules that are co-agonists for multiple gut hormones including GLP-1, glucagon, and gastric inhibitory peptide.
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Affiliation(s)
- Daniel H Bessesen
- School of Medicine, Division of Endocrinology, Metabolism and Diabetes, Denver Health Medical Center, University of Colorado, Denver, CO, USA.
| | - Luc F Van Gaal
- Department of Endocrinology, Diabetology and Metabolism, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
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Danan ER, Krebs EE, Ensrud K, Koeller E, MacDonald R, Velasquez T, Greer N, Wilt TJ. An Evidence Map of the Women Veterans' Health Research Literature (2008-2015). J Gen Intern Med 2017; 32:1359-1376. [PMID: 28913683 PMCID: PMC5698220 DOI: 10.1007/s11606-017-4152-5] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 06/08/2017] [Accepted: 07/27/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Women comprise a growing proportion of Veterans seeking care at Veterans Affairs (VA) healthcare facilities. VA initiatives have accelerated changes in services for female Veterans, yet the corresponding literature has not been systematically reviewed since 2008. In 2015, VA Women's Health Services and the VA Women's Health Research Network requested an updated literature review to facilitate policy and research planning. METHODS The Minneapolis VA Evidence-based Synthesis Program performed a systematic search of research related to female Veterans' health published from 2008 through 2015. We extracted study characteristics including healthcare topic, design, sample size and proportion female, research setting, and funding source. We created an evidence map by organizing and presenting results within and across healthcare topics, and describing patterns, strengths, and gaps. RESULTS We identified 2276 abstracts and assessed each for relevance. We excluded 1092 abstracts and reviewed 1184 full-text articles; 750 were excluded. Of 440 included articles, 208 (47%) were related to mental health, particularly post-traumatic stress disorder (71 articles), military sexual trauma (37 articles), and substance abuse (20 articles). The number of articles addressing VA priority topic areas increased over time, including reproductive health, healthcare organization and delivery, access and utilization, and post-deployment health. Three or fewer articles addressed each of the common chronic diseases: diabetes, hypertension, depression, or anxiety. Nearly 400 articles (90%) used an observational design. Eight articles (2%) described randomized trials. CONCLUSIONS Our evidence map summarizes patterns, progress, and growth in the female Veterans' health and healthcare literature. Observational studies in mental health make up the majority of research. A focus on primary care delivery over clinical topics in primary care and a lack of sex-specific results for studies that include men and women have contributed to research gaps in addressing common chronic diseases. Interventional research using randomized trials is needed.
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Affiliation(s)
- Elisheva R Danan
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA. .,Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.
| | - Erin E Krebs
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA.,Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Kristine Ensrud
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA.,Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Eva Koeller
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA
| | - Roderick MacDonald
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA
| | - Tina Velasquez
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA
| | - Nancy Greer
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA
| | - Timothy J Wilt
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA.,Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
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22
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Goodrich DE, Klingaman EA, Verchinina L, Goldberg RW, Littman AJ, Janney CA, Kim HM, Maguen S, Hoerster KD, Owen RR, Holleman RG, Roman P, Lai Z, Bowersox NW. Sex Differences in Weight Loss among Veterans with Serious Mental Illness: Observational Study of a National Weight Management Program. Womens Health Issues 2016; 26:410-9. [PMID: 27365284 DOI: 10.1016/j.whi.2016.05.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 04/14/2016] [Accepted: 05/10/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Obesity disproportionately burdens individuals with serious mental illness (SMI), especially women. This observational study investigated whether there were sex differences in weight loss and program participation among veterans with SMI enrolled in the Veterans Health Administration's (VHA) MOVE! weight management program. PROCEDURES Participants were identified from a national cohort of 148,254 veterans enrolled in MOVE! during fiscal years 2008 through 2012 who attended two or more sessions within 12 months of enrollment. The cohort included those with International Classification of Disease, 9th Edition, Clinical Modification (ICD-9-CM) diagnoses for SMI, age less than 70 years, and weight data at baseline and one or more follow-up timepoints within approximately 1 year of enrollment (n = 8,943 men; n = 2,245 women). Linear mixed models assessed associations of sex with 6- and 12-month weight change from baseline, adjusting for demographic- and site-level variables. FINDINGS Both sexes averaged 6.4 (standard deviation, 4.6) sessions within 12 months; however, women with and without SMI participated at rates double their respective proportion rates among all VHA users. Participants averaged statistically significant weight loss at 6 months (men, -2.5 lb [95% CI, -2.8 to -2.1]; women, -2.4 lb [95% CI, -3.1 to -1.7]) and 12 months (men, -2.5 lb [95% CI, -2.8 to -2.2]; women, -2.9 lb [95% CI, -3.6 to -2.2]), but no sex-based difference in absolute weight loss at either timepoint. Slightly more women achieved 5% or greater (clinically significant) weight loss at the 12-month follow-up than did men (25.7% vs. 23.0%; p < .05). CONCLUSIONS Women with SMI participated in MOVE! at rates equivalent to or greater than men with SMI, with comparable weight loss. More women were Black, single, had bipolar and posttraumatic stress disorder, and higher service-connected disability, suggesting areas for program customization.
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Affiliation(s)
- David E Goodrich
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Elizabeth A Klingaman
- VA Maryland Health Care System, Baltimore VA Medical Center, Baltimore, Maryland; Department of Psychiatry, University of Maryland School of Medicine, Division of Psychiatric Services Research, Baltimore, Maryland.
| | - Lilia Verchinina
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Richard W Goldberg
- VA Maryland Health Care System, Baltimore VA Medical Center, Baltimore, Maryland; Department of Psychiatry, University of Maryland School of Medicine, Division of Psychiatric Services Research, Baltimore, Maryland
| | - Alyson J Littman
- Epidemiologic Research and Information Center, VA Puget Sound Medical Center, Seattle, Washington; Department of Epidemiology, University of Washington, Seattle, Washington
| | - Carol A Janney
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Hyungjin Myra Kim
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan; Center for Statistical Consultation & Research, University of Michigan, Ann Arbor, Michigan
| | - Shira Maguen
- San Francisco VA Medical Center, San Francisco, California; Department of Psychiatry, University of California, San Francisco, California
| | - Katherine D Hoerster
- Mental Health Service, VA Puget Sound Healthcare System, Seattle, Washington; University of Washington Department of Psychiatry and Behavioral Sciences, Seattle, Washington
| | - Richard R Owen
- VA Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas; Department of Psychiatry, Psychiatric Research Institute, University of Arkansas for Medical Sciences College of Medicine, Little Rock, Arkansas
| | - Robert G Holleman
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Pia Roman
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Zongshan Lai
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Nicholas W Bowersox
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan; VA Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC), Ann Arbor, Michigan
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23
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Bessesen D. Expert interview: New ENDO guidelines. Obesity (Silver Spring) 2015; 23 Suppl 1:S13-4. [PMID: 25900869 DOI: 10.1002/oby.21096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Daniel Bessesen
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado, Aurora, CO
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