Characteristics of patients potentially eligible for pharmacotherapy for weight loss in primary care practice in the United States

Perceptions of Obesity Among Healthcare Professionals and Policy Makers in 2023: Results of the Global OPEN Survey

Objective

Obesity is a disease with severe health impacts on individuals and economic impacts on society, yet healthcare practitioners (HCPs) and policy makers often fail to address it. This survey was conducted to examine current global obesity care and perceptions influencing care delivery among HCPs and healthcare decision makers (HC DMs).

Methods

A survey with a cross-sectional design was conducted among 1200 HCPs (primary care providers, endocrinologists, cardiologists, and nurses) and 414 HC DMs from eight countries across five continents. Respondents' perceptions of obesity, characteristics of patient populations, obesity management practices, and obesity-related healthcare policies were collected. Surveys were administered online from June-July 2023. All respondent data were anonymized.

Results

Among HCPs, 26.4% and 29.0% of HC DMs considered obesity a chronic disease, and 44.6% of HCPs reported that obesity was recorded as a chronic disease in patients' medical records. The pattern of responses was consistent across countries and professional roles. Obesity care approaches focused on lifestyle concerns. HCPs and HC DMs appeared to overestimate the provision of obesity-related medical care for affected patients.

Conclusion

These results corroborate prior findings that many HCPs do not consider obesity a disease, which hinders initiation of appropriate treatment, and also highlight challenges in obesity management, including gaps in obesity guidelines and accessibility to healthcare. These findings may help guide education and outreach by health authorities as well as HCPs.

Utilization of antiobesity medications within the Military Health System

OBJECTIVE

The prevalence of overweight and obesity among beneficiaries of the Military Health System (MHS) is 41.6% and 30.5%, respectively. This incurs significant medical, fiscal, and military readiness costs. It is not currently known how the utilization of antiobesity medications (AOMs) within the MHS compares with that in the Veterans Health Administration or the private sector. Our aim was to assess the utilization of AOMs within the MHS.

METHODS

A cross-sectional study was conducted using data gathered from the MHS Data Repository and the inclusion of all adult TRICARE Prime and Plus beneficiaries ages 18 to 64 years who were prescribed at least one TRICARE-approved AOM during the years 2018 to 2022.

RESULTS

The total study population included 4,414,127 beneficiaries, of whom 1,871,780 were active-duty service members. The utilization of AOMs among the eligible population was 0.56% (0.44% among active-duty personnel). Liraglutide was the most-prescribed AOM (36% of the total). Female sex, age greater than or equal to 30 but less than 60 years, and enlisted or warrant officer rank were all associated with statistically significant higher odds of receiving AOMs.

CONCLUSIONS

Comparable with the US private sector, the MHS significantly underutilizes AOMs, including among active-duty service members, despite coverage of AOMs since 2018.

Weight loss medication prescription prevalence in the active component, 2018-2023

The U.S. military has witnessed rising obesity among active component service members. The Department of Defense authorized coverage of weight loss medications in 2018, but no study has evaluated prescription prevalence within the active component. This descriptive retrospective cohort study analyzed data from active component U.S. military service members from January 2018 through June 2023. The study used data from the Defense Medical Surveillance System to determine prescription period prevalence of weight loss medication. Data on demographics, body mass index, and history of diabetes were considered. The study revealed a 100-fold increase in the prescription period prevalence of weight loss agents in the active component from their initial authorization date. Demographics associated with higher prescription period prevalence were non-Hispanic Black race and ethnicity, female sex, and older age. Service members in the health care occupations and the Navy had higher prevalence compared to other service branches and occupations. The findings indicate a significant rise in the period prevalence of weight loss prescriptions over time. Further research is recommended to assess the effectiveness, safety, and use in austere military environments.

Prevalence and Overlap of Cardiac, Renal, and Metabolic Conditions in US Adults, 1999-2020

Importance

Individually, cardiac, renal, and metabolic (CRM) conditions are common and leading causes of death, disability, and health care-associated costs. However, the frequency with which CRM conditions coexist has not been comprehensively characterized to date.

Objective

To examine the prevalence and overlap of CRM conditions among US adults currently and over time.

Design, Setting, and Participants

To establish prevalence of CRM conditions, nationally representative, serial cross-sectional data included in the January 2015 through March 2020 National Health and Nutrition Examination Survey (NHANES) were evaluated in this cohort study. To assess temporal trends in CRM overlap, NHANES data between 1999-2002 and 2015-2020 were compared. Data on 11 607 nonpregnant US adults (≥20 years) were included. Data analysis occurred between November 10, 2020, and November 23, 2022.

Main Outcomes and Measures

Proportion of participants with CRM conditions, overall and stratified by age, defined as cardiovascular disease (CVD), chronic kidney disease (CKD), type 2 diabetes (T2D), or all 3.

Results

From 2015 through March 2020, of 11 607 US adults included in the analysis (mean [SE] age, 48.5 [0.4] years; 51.0% women), 26.3% had at least 1 CRM condition, 8.0% had at least 2 CRM conditions, and 1.5% had 3 CRM conditions. Overall, CKD plus T2D was the most common CRM dyad (3.2%), followed by CVD plus T2D (1.7%) and CVD plus CKD (1.6%). Participants with higher CRM comorbidity burden were more likely to be older and male. Among participants aged 65 years or older, 33.6% had 1 CRM condition, 17.1% had 2 CRM conditions, and 5.0% had 3 CRM conditions. Within this subset, CKD plus T2D (7.3%) was most common, followed by CVD plus CKD (6.0%) and CVD plus T2D (3.8%). The CRM comorbidity burden was disproportionately high among participants reporting non-Hispanic Black race or ethnicity, unemployment, low socioeconomic status, and no high school degree. Among participants with 3 CRM conditions, nearly one-third (30.5%) did not report statin use, and only 4.8% and 3.0% used glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter 2 inhibitors, respectively. Between 1999 and 2020, the proportion of US adults with multiple CRM conditions increased significantly (from 5.3% to 8.0%; P < .001 for trend), as did the proportion having all 3 CRM conditions (0.7% to 1.5%; P < .001 for trend).

Conclusions and Relevance

This cohort study found that CRM multimorbidity is increasingly common and undertreated among US adults, highlighting the importance of collaborative and comprehensive management strategies.

Use of medications associated with weight change among participants in the All of Us research programme

Our objective was to describe the use of medications associated with weight change among US adults with overweight/obesity, including anti-obesity medications (AOMs), weight-loss-promoting and weight-gain-promoting medications. We performed a cross-sectional analysis of data from the nationwide All of Us Research Programme. We included adults with measured body mass index (BMI) ≥ 27 kg/m2 enrolled between 2018 and 2022 across the United States. We used linked electronic health record data to determine medication use ±12 months of BMI measure. Our 132 057 participants had mean age 54 years and mean BMI 34 kg/m2 ; 60% of participants were women, 62% White, and 32% Black. Only 1% used any AOM, and 14% used at least one weight-loss-promoting medication. We found that 36% used at least one weight-gain-promoting medication, and approximately 20% used multiple weight-gain-promoting medications. While AOMs are underutilized by participants with overweight/obesity, weight-gain-promoting medication use is common. Our results raise concern about potential iatrogenic weight gain from medications. Future research is needed to estimate the long-term effect of weight-gain-promoting medications on weight status and determine whether weight-loss benefits occur with their discontinuation. Clinician education on AOMs and weight-loss-promoting medications may be needed to increase their use.

Pharmacological profile of once-weekly injectable semaglutide for chronic weight management

INTRODUCTION

The recent approval in the USA (Food and Drug Administration), Canada (Health Canada), UK (Medicines and Healthcare products Regulatory Agency), and EU (European Medicines Agency) of once-weekly injectable semaglutide 2.4 mg, as an adjunct to a calorie-controlled diet and increased physical activity, for chronic weight management provides health-care practitioners with an additional option when prescribing weight-loss medication.

AREAS COVERED

We describe the chemistry, mechanism of action, and pharmacological properties of semaglutide (a glucagon-like peptide 1 receptor agonist [GLP-1 RA]) and discuss clinical data and considerations for using once-weekly subcutaneous semaglutide 2.4 mg as treatment for overweight and obesity among patients with and without type 2 diabetes (T2D).

EXPERT OPINION

Once-weekly subcutaneous semaglutide 2.4 mg is the most efficacious medication approved for chronic weight management among patients with overweight and obesity, with and without T2D, and is the first drug to induce sustained double-digit reductions in percentage body weight over 1- to 2-year treatment periods. It demonstrates a similar safety and tolerability profile to other GLP-1 RAs. Semaglutide 2.4 mg treatment could dramatically improve clinical approaches to weight management, but the relatively high cost might prevent patients accessing treatment. Further research exploring the cost-effectiveness of subcutaneous semaglutide 2.4 mg is required.

Weight-Loss Strategies for Prevention and Treatment of Hypertension: A Scientific Statement From the American Heart Association

Hypertension is a major risk factor for cardiovascular and renal diseases in the United States and worldwide. Obesity accounts for much of the risk for primary hypertension through several mechanisms, including neurohormonal activation, inflammation, and kidney dysfunction. As the prevalence of obesity continues to increase, hypertension and associated cardiorenal diseases will also increase unless more effective strategies to prevent and treat obesity are developed. Lifestyle modification, including diet, reduced sedentariness, and increased physical activity, is usually recommended for patients with obesity; however, the long-term success of these strategies for reducing adiposity, maintaining weight loss, and reducing blood pressure has been limited. Effective pharmacotherapeutic and procedural strategies, including metabolic surgeries, are additional options to treat obesity and prevent or attenuate obesity hypertension, target organ damage, and subsequent disease. Medications can be useful for short- and long-term obesity treatment; however, prescription of these drugs is limited. Metabolic surgery is effective for producing sustained weight loss and for treating hypertension and metabolic disorders in many patients with severe obesity. Unanswered questions remain related to the mechanisms of obesity-related diseases, long-term efficacy of different treatment and prevention strategies, and timing of these interventions to prevent obesity and hypertension-mediated target organ damage. Further investigation, including randomized controlled trials, is essential to addressing these questions, and emphasis should be placed on the prevention of obesity to reduce the burden of hypertensive cardiovascular and kidney diseases and subsequent mortality.

Anti-obesity Medication Use Among Adults with Overweight and Obesity in the United States: 2015-2018

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.

Physicians' political party affiliation and clinical management of obesity

Studies have documented that few patients with obesity receive evidence-based care. One provider characteristic that may impact clinical obesity care, but that has been under studied to date, is political party affiliation. This study sought to evaluate how primary care physicians (PCPs) report managing patients with obesity and assess whether there are differences between Democratic and Republican PCPs. This was a secondary analysis of a cross-sectional survey of 225 PCPs registered to vote as Democrats or Republicans in 29 US States. After reading a patient vignette, the PCPs reported the following outcomes: likelihood of documenting obesity in the medical record; likelihood of discussing obesity with the patient; and likelihood of engaging in eight different obesity management options. Almost all PCPs reported they would document obesity in the medical record (Republican = 97.6%, Democrat = 94.3%) and discuss it further (Republican = 95.2%, Democrat = 92.2%). Among eight obesity management options, PCPs were least likely to say they would prescribe medication (3.9%) or refer the patient to counselling (24.0%), regardless of political affiliation. Republicans were more likely to report that they would inquire about the time course of obesity (73.4% v. 56.2%, P = 0.012) and discuss health risks of obesity (91.0% vs 78.3%, P = .018). Republican and Democratic PCPs report some differences in managing patients with obesity, suggesting that political beliefs may play a role in some clinical care.

Pharmacotherapy for Obesity-Trends Using a Population Level National Database

BACKGROUND

Despite the growing trend of obesity, the utilization of anti-obesity therapeutic interventions is not robust in the USA. We aimed to analyze the trends of anti-obesity pharmacotherapy using a population level database.

METHODS

We used an electronic health record-derived database (Explorys, IBM Watson Health) to identify adults with obesity (body mass index ≥ 30 kg/m²), 2010-2019. Annual rates of anti-obesity pharmacotherapy were analyzed. To assess post-bariatric utilization of these medications, the trend of adults with morbid obesity (BMI ≥ 40 kg/m ²) who were newly started on anti-obesity medications after sleeve gastrectomy was also analyzed.

RESULTS

Among 11,195,020 adults with obesity, 274,160 (2.4%) were prescribed anti-obesity medications during the study period with an increase from 1.1% in 2010 to 2.9% in 2019 (p < 0.0001). A total of 900 (3.5%) of those with morbid obesity were started on weight loss medications within 5 years of sleeve gastrectomy. Women [odds ratio (OR) 3.57, 95% confidence interval (CI) 3.51-3.58], individuals under 50 years (OR 1.59, CI 1.57-1.60), non-Hispanics (OR 1.12, 1.10-1.14, p < 0.0001), African Americans (OR 1.18, CI 1.16-1.19), Medicaid (OR 1.70, CI 1.67-1.73), and commercial insurance holders (OR 2.46, 2.43-2.49) were more likely to receive anti-obesity pharmacotherapy, p < 0.001 for all comparisons.

CONCLUSION

There has been a modest increase in the prevalence of anti-obesity medications in the last 10 years, but they remain significantly underutilized. Further studies addressing the barriers to anti-obesity pharmacotherapy might help in increasing the utilization of these medications among adults with obesity.

Anti-obesity drug therapy in clinical practice: Evidence of a poor prescriptive attitude

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 (r_s 0.14; p < 0.01), diabetes (r_s 0.19; p < 0.01), hypertension (r_s 0.14; p < 0.01), heart failure (r_s 0.09; p < 0.01), HCVr (r_s 0. 12; p < 0.01) and number of comorbidities (r_s 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.

Barriers and Solutions for Prescribing Obesity Pharmacotherapy

There are many valid reasons why health care providers are reluctant to use pharmacotherapy for weight management: the negative track record of weight loss medications has led to numerous safety concerns, and there is lack of formal training in obesity medicine and a general discomfort with using these medications. New medications have improved safety profiles, and their mechanisms are based on recent discoveries of how humans regulate weight. This, combined with a change in American health coverage, has slowly increased the use weight loss medication. This article examines the barriers and changes that are increasing the use of anti-obesity medications.

Effects of a novel combination of orlistat and acarbose on tolerability, appetite, and glucose metabolism in persons with obesity

OBJECTIVE

There is an unmet medical need for a safe and effective weight loss product with minimal systemic side-effects. In this study, the effect of a novel modified-release fixed-dose combination of orlistat and acarbose (MR-OA) was compared with conventional orlistat (CO) regarding tolerability, appetite and glucose metabolism.

METHODS

Sixty-seven men with obesity, aged 24 to 60 years with body mass indexes (BMIs) 33 to 40 kg m-2 or BMIs 30 to 32 kg m-2 and waist circumference above 102 cm were included. They were randomized to either three different doses of the test formulation MR-OA (60 mg orlistat/20 mg acarbose, 90/30 and 120/40) or CO (Xenical, 120 mg orlistat) for a 2-week study of daily treatment. The participants spent days 1 and 14 at the clinical research centre where they received standardized meals, had blood sampling and filled in questionnaires regarding tolerability and appetite after meals. In days 2 to 13, the participants were at home and continued to fill in the questionnaires daily.

RESULTS

In the MR-OA groups, reports of liquid and oily stools as well as faecal incontinence were fewer, whereas reports of gastric distension and flatulence were higher, compared with the CO group. More participants reported decreased hunger in the 90/30 and 120/40 MR-OA, and postprandial plasma glucose concentration was reduced in all MR-OA groups compared with CO.

CONCLUSIONS

This study shows that by using a modified-release dosage form, orlistat and acarbose can be combined without compromising tolerability. Furthermore, MR-OA shows promising effects regarding reduction of appetite and reduces postprandial glucose. Tolerability is coupled to compliance and thereby efficacy of a treatment; therefore, this novel combination MR-OA could be an effective approach for weight loss treatment. A follow-up study in a more diverse population and for a longer duration with weight loss as primary outcome variable is planned.

Pharmacotherapy of Obesity: Limits and Perspectives

Obesity is a severe worldwide epidemic. Obesity comorbidities, such as type 2 diabetes mellitus, hypertension, and atherosclerosis, are costly for patients and governments. The treatment of obesity involves several facets, including lifestyle changes, bariatric surgery, and pharmacotherapy. As changes in lifestyle require considerable patient commitment that is sometimes unachievable, and surgery is expensive and invasive, pharmacotherapy is the primary option for most patients. This review describes the pharmacotherapy currently available in the USA, Europe, and Brazil, focusing on its limitations. We then analyze the results from clinical trials of new drug candidates. Most drugs cause weight loss of < 4 kg compared with controls, and severe adverse effects have caused a number of drugs to be withdrawn from the market in several countries. Drugs under development have not shown more significant weight loss or reduced adverse effects. We conclude that a significant portion of obese patients have few treatment options because of the adverse effects and minimal weight loss associated with current pharmacotherapy. However, drugs currently under development appear unable to change this scenario in the near future. Thus, it is essential that new compounds are developed and new molecular targets studied so obesity can be efficiently treated in all patients in the future.

PROVIDER PRACTICE HABITS AND BARRIERS TO CARE IN OBESITY MANAGEMENT IN A LARGE MULTICENTER HEALTH SYSTEM

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.

Progress and challenges in anti-obesity pharmacotherapy

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, GABA_A 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.

Introduction: The State of Obesity in 2017

Obesity continues to be a major national and global health challenge and a risk factor for an expanding set of chronic diseases. In 2015, high body mass index contributed to 4.0 million deaths globally, which represented 7.1% of the deaths from any cause. Obesity is now regarded as a disease, and multiple health care societies have begun to tackle obesity as a discrete target for assessment and treatment that is supported by several position statements and guidelines. Nonetheless, a perception and treatment gap continues to exist between health care providers and patients regarding the provision of obesity care.

Current practices of obesity pharmacotherapy, bariatric surgery referral and coding for counselling by healthcare professionals

INTRODUCTION

Rates of obesity pharmacotherapy use, bariatric surgery and intensive behavioural counselling have been extremely low.

OBJECTIVES

The primary objective of this study was to survey healthcare provider beliefs, practice and knowledge regarding obesity management.

METHODS

Primary care physicians (PCPs), OB-GYN physicians and nurse practitioners (NPs) responded to a web-based survey related to drug therapy practice, bariatric surgery referral and reimbursement coding practice.

RESULTS

Rates of reported use of obesity pharmacotherapy appear to be increasing among PCPs, which is likely related to the approval of four new obesity pharmacotherapy agents since 2012. Rates of pharmacotherapy use among OB-GYNs and NPs appear much lower. Similarly, few PCPs are averse to recommending bariatric surgery, but aversion among OB-GYNs and NPs is significantly higher.

CONCLUSION

Together, these observations suggest that OB-GYN and NP populations are important targets for education about obesity management. Very few PCPs, OB-GYNs or NPs use behavioural counselling coding for obesity. Better understanding of why this benefit is not being fully used could inform outreach to improve counselling rates.

Characteristics of patients potentially eligible for pharmacotherapy for weight loss in primary care practice in the United States

Objective

To describe the characteristics of real‐world patients potentially eligible for adjunctive pharmacotherapy for weight loss.

Methods

Patients from the GE Centricity electronic medical record database were selected if they had body mass index (BMI) ≥30 or ≥27 to <30 kg m⁻² with ≥1 obesity‐associated comorbidity (hypertension, dyslipidemia, or type 2 diabetes) from 2002–2011; were aged ≥18 years and had ≥12 months of continuous enrollment before and after the date of first eligible BMI recorded (index date). Descriptive statistics and logistic regression were used for analysis.

Results

Of the 1,835,541 patients with overweight or obesity included, comorbidities were common (hypertension [55.4%], dyslipidemia [36.1%] and type 2 diabetes [13.4%]). The percentage of patients who received pharmacotherapy for weight loss was 0.7% within 12 months after the index date. Patients who received pharmacotherapy had higher BMI (median, 33.6 vs. 31.3 kg m⁻²), were younger (median, 42 vs. 52 years), primarily women (84.3 vs. 58.2%), commercially insured (70.1 vs. 50.4%) and had more frequent use of antidepressants (30.8 vs. 14.1%) and non‐steroidal anti‐inflammatory drugs (21.7 vs. 12.0%) than those who did not at baseline (all P values < 0.0001).

Conclusions

Few eligible patients received pharmacotherapy for weight loss. Patients who received pharmacotherapy tended to be heavier, younger, female, commercially insured, and used more antidepressants and non‐steroidal anti‐inflammatory drugs.