How many people with obesity actually receive prescriptions for weight management medication?

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Older data have shown that obesity medications are prescribed far less frequently than medications for other chronic medical conditions like type 2 diabetes, with only about 2% of people with obesity receiving treatment with medication. Much has changed in recent years in the weight management world. How has this impacted prescribing of weight management medication?

A recent retrospective study looked at American electronic health records from a large health system in Florida and Ohio. They evaluated data from January 2015 until June 2023 on people with body mass index (BMI) of at least 30 kg/m2 who had at least one visit with their family doctor, and who had either sought or received weight management care (defined by attending at least one weight management program or receiving an initial prescription for weight management medication). They evaluated prescribing of the five obesity medications available in USA for long term weight management during that time [naltrexone-bupropion (Contrave), orlistat (Xenical), phentermine-topiramate (Qsymia, not available in Canada), liraglutide 3mg (Saxenda), and semaglutide 2.4mg (Wegovy)]. They excluded dosage forms of liraglutide and semaglutide approved for diabetes management (Victoza and Ozempic, respectively).

Out of a total of about 250,000 people with obesity, the study identified just over 50,000 people who had either sought or received obesity care during this time frame. They found that only 8% of these people (about 4,000) had received a prescription for obesity pharmacotherapy, and only 4.4% had filled prescriptions for these treatments. They found that medical insurance presence and type affected whether or not a prescription was given, and whether it was filled (no surprise here). People who identified as being male, ethnic minorities, and lower socioeconomic status were less likely to receive a new prescription.

So by my math, this works out to about 1.6% of people with obesity who had been prescribed an obesity medication, similar to older data. I would be interested to see what the trend looked like in the last year of the study (ending in 2023) compared to the first year (2015), as use of weight management medication has certainly been on the rise, with the advent of the more effective ozempic (Wegovy) and tirzepatide (Zepbound) obesity treatments. It should also be noted that some avenues of getting prescriptions for medication may not have been captured in this database. That being said, the barriers and disparities identified by the study remain: cost, access, insurance coverage, and socioeconomic/ethnic disparities. While these data come from USA, where costs of these medications are amongst the highest in the world, cost, access, insurance coverage, and socioeconomic disparities resonate around the world.

BOTTOM LINE: Obesity medications remain underutilized, with cost, insurance, access, and socioeconomic disparites presenting barriers to treatment. Stay tuned for more about barriers to treatment in an upcoming blog post!

Disclaimer: I receive honoraria as a continuing medical education speaker and consultant from the maker of semaglutide and liraglutide (Novo Nordisk), naltrexone/bupropion (Bausch), and tirzepatide (Eli Lilly). I am/have been an investigator in clinical trials of semaglutide, liraglutide, and tirzepatide.

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