In the Journals

US veterans with obesity underutilize weight management medications

Just 1.1% of U.S. veterans with obesity utilize weight management medications, with orlistat the most popular option, according to findings published in Obesity.

“A recent study of the efficacy of [weight management medications] in the [Veterans Health Administration] found that patients who used [weight management medications] together with MOVE! achieved significantly greater weight loss compared with patients who participated in MOVE! without using [weight management medications],” Varsha G. Vimalananda, MD, MPH, an assistant professor of medicine in the section of endocrinology, diabetes, nutrition and weight management of the department of medicine at Boston University School of Medicine and a physician/scientist at the Center for Healthcare Organization and Implementation Research at Edith Nourse Rogers Memorial Veterans Hospital in Bedford, Massachusetts, and colleagues wrote. “Hence, there is a strong rationale to incorporate [weight management medications] more routinely into obesity treatment in the [Veterans Health Administration]. However, there is evidence that [weight management medications] are widely underused compared with pharmacotherapies for other chronic diseases.”

Using electronic health records from a Veterans Health Administration database, Vimalananda and colleagues identified 153,393 veterans (34% aged 65 years; 15.1% women) who participated in the MOVE! program between 2013 and 2016. According to the researchers, all veterans had a BMI of more than 30 kg/m2 or a combination of a BMI of at least 27 kg/m2 and diabetes, hypertension, hyperlipidemia, cardiovascular disease, obstructive sleep apnea, nonalcoholic fatty liver disease, osteoarthritis or depression.

The researchers found that a weight management medication prescription was filled by 1.1% of those in the cohort, with 70.4% of those prescriptions for orlistat (Xenical, Cheplapharm). Those who were aged 45 to 54 years were more likely to have a weight management medication prescription compared with those who were aged 18 to 34 years (adjusted OR = 1.2; 95% CI, 1-1.5). Women had higher odds of having a prescription filled compared with men (aOR = 2.1; 95% CI, 1.8-2.3), and those with class 1 (aOR = 1.9; 95% CI, 1.4-2.4), class 2 (aOR = 3.2; 95% CI, 2.5-4.1) and class 3 (aOR = 5.2; 95% CI, 4.1-6.7) obesity had greater odds for filling a prescription than those who with overweight. Those with osteoarthritis (aOR = 1.3; 95% CI, 1.2-1.4), obstructive sleep apnea (aOR = 1.3; 95% CI, 1.2-1.5), depression (aOR = 1.1; 95% CI, 1-1.2), lower back pain (aOR = 1.2; 95% CI, 1.1-1.3) or a history of alcohol abuse (aOR = 1.7; 95% CI, 1.3-2.3) were more likely to have at least one filled weight management medication prescription, the researchers wrote, whereas the odds of having one were lower for those having a copayment for the prescription (aOR = 0.8; 95% CI, 0.7-0.8) or being aged 65 years (aOR = 0.7; 95% CI, 0.5-0.8) or of Hispanic ethnicity (aOR = 0.8; 95% CI, 0.6-0.9).

“Our findings have implications for system improvement efforts given that nearly 4 million veterans with overweight or obesity receive care in the [Veterans Health Administration] and given that the burden of obesity-related comorbidities is likely to increase over time,” the researchers wrote. “Data are needed on factors at the system, clinician and patient level that influence use of [weight management medications] to supplement behavioral weight-loss treatment.” – by Phil Neuffer

Disclosures: The authors report no relevant financial disclosures. 

Just 1.1% of U.S. veterans with obesity utilize weight management medications, with orlistat the most popular option, according to findings published in Obesity.

“A recent study of the efficacy of [weight management medications] in the [Veterans Health Administration] found that patients who used [weight management medications] together with MOVE! achieved significantly greater weight loss compared with patients who participated in MOVE! without using [weight management medications],” Varsha G. Vimalananda, MD, MPH, an assistant professor of medicine in the section of endocrinology, diabetes, nutrition and weight management of the department of medicine at Boston University School of Medicine and a physician/scientist at the Center for Healthcare Organization and Implementation Research at Edith Nourse Rogers Memorial Veterans Hospital in Bedford, Massachusetts, and colleagues wrote. “Hence, there is a strong rationale to incorporate [weight management medications] more routinely into obesity treatment in the [Veterans Health Administration]. However, there is evidence that [weight management medications] are widely underused compared with pharmacotherapies for other chronic diseases.”

Using electronic health records from a Veterans Health Administration database, Vimalananda and colleagues identified 153,393 veterans (34% aged 65 years; 15.1% women) who participated in the MOVE! program between 2013 and 2016. According to the researchers, all veterans had a BMI of more than 30 kg/m2 or a combination of a BMI of at least 27 kg/m2 and diabetes, hypertension, hyperlipidemia, cardiovascular disease, obstructive sleep apnea, nonalcoholic fatty liver disease, osteoarthritis or depression.

The researchers found that a weight management medication prescription was filled by 1.1% of those in the cohort, with 70.4% of those prescriptions for orlistat (Xenical, Cheplapharm). Those who were aged 45 to 54 years were more likely to have a weight management medication prescription compared with those who were aged 18 to 34 years (adjusted OR = 1.2; 95% CI, 1-1.5). Women had higher odds of having a prescription filled compared with men (aOR = 2.1; 95% CI, 1.8-2.3), and those with class 1 (aOR = 1.9; 95% CI, 1.4-2.4), class 2 (aOR = 3.2; 95% CI, 2.5-4.1) and class 3 (aOR = 5.2; 95% CI, 4.1-6.7) obesity had greater odds for filling a prescription than those who with overweight. Those with osteoarthritis (aOR = 1.3; 95% CI, 1.2-1.4), obstructive sleep apnea (aOR = 1.3; 95% CI, 1.2-1.5), depression (aOR = 1.1; 95% CI, 1-1.2), lower back pain (aOR = 1.2; 95% CI, 1.1-1.3) or a history of alcohol abuse (aOR = 1.7; 95% CI, 1.3-2.3) were more likely to have at least one filled weight management medication prescription, the researchers wrote, whereas the odds of having one were lower for those having a copayment for the prescription (aOR = 0.8; 95% CI, 0.7-0.8) or being aged 65 years (aOR = 0.7; 95% CI, 0.5-0.8) or of Hispanic ethnicity (aOR = 0.8; 95% CI, 0.6-0.9).

“Our findings have implications for system improvement efforts given that nearly 4 million veterans with overweight or obesity receive care in the [Veterans Health Administration] and given that the burden of obesity-related comorbidities is likely to increase over time,” the researchers wrote. “Data are needed on factors at the system, clinician and patient level that influence use of [weight management medications] to supplement behavioral weight-loss treatment.” – by Phil Neuffer

Disclosures: The authors report no relevant financial disclosures.