As a counterpoint to last week’s blog about whether a person could be on ‘too much’ diabetes medication, this weekend I am drawing attention to the fact that most people with elevated weight have never been offered weight loss medication by their doctors.
Say what?! Yes, it’s true. Despite the parallels and commonalities between type 2 diabetes and obesity, the obesity treatment world looks very different (and sadly so).
A study from a few years back looked at prescribing patterns of diabetes medications, compared to prescribing patterns of weight management medications. The authors evaluated a US database retrospectively, between 2012-2015. At that time, 46% of Americans fit the criteria for use of weight management medications, and 8.4% of Americans had been diagnosed with diabetes (both numbers have gone up since then). They found that the number of dispensed diabetes prescriptions (excluding insulin) was 15 times the number of dispensed obesity prescriptions.
They also looked at patterns of prescribing of new classes of medications for diabetes and obesity. During the time frame of the study (2012-2015), SGLT2 inhibitors were introduced as a new class of diabetes medication. During that time, the new obesity medications were naltrexone/bupropion (Contrave), phentermine/topiramate (Qsymia, not available in Canada), and lorcaserin (which was never available in Canada, and has since been withdrawn from the US market). They found that the adoption rate of SGLT2 inhibitors for diabetes was nearly exponential, while the adoption rate of new obesity medications was linear (ie much slower).
The obesity medication landscape has certainly expanded since these data were collected. The GLP1 receptor agonist class for weight management was not available back then (liraglutide 3mg (Saxenda) and semaglutide 2.4mg (Wegovy)). Many steps forward have been taken on education and advocacy around weight management since that time as well.
Due to our natural human biology that vigorously defends our weight, most people who struggle with elevated weight are not able to lose and sustain weight with lifestyle approaches alone. Obesity is a chronic medical condition, and deserves treatment, just like other chronic medical conditions such as diabetes.
As the authors conclude,
Considering the relative prevalence of obesity to diabetes, and that obesity is a major CAUSE of diabetes, these results are paradoxical, and suggest systematic barriers against the prescribing of antiobesity pharmacotherapies (weight management medications).
I would love to see this study conducted every 5 years to reassess prescribing patterns, in hopes that obesity is more often getting the treatment it deserves.
Disclaimer: I am an investigator and coauthor of several studies of liraglutide and semaglutide. I receive honoraria as a continuing medical education speaker and consultant from the maker of liraglutide and semaglutide (Novo Nordisk), and naltrexone/bupropion (Bausch).
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