Prefer to listen? Check out my podcast here!
As blogged previously, although use is certainly on the rise, obesity medications are still vastly underutilized. I was asked to speak at the recent American Diabetes Association meeting alongside my friends and colleagues Dr Robert Kushner and Dr Vanita Aroda, with one of the topics being to identify barriers to treatment with weight management medications, and strategies to overcome these barriers.
In my session, I discussed 5 key barriers:
BARRIER: Lack of understanding that obesity is a chronic disease.
All too often, health care providers harbor the belief that ‘eat less, move more’ works, or that once weight loss is achieved with treatment, that treatment can be stopped (whereas all studies show that weight goes back up after treatment is stopped). People with elevated weight sometimes feel that ‘I should be able to do it on my own’, and have perhaps been shamed into believing that it is their own fault and due to their lifestyle ‘choices’. Some people may be reluctant to consider long term medication, and payors are reluctant to pay for them.
Strategies to overcome this barrier: It’s important for health care professionals, insurance/payors, and people with obesity to understand that our natural human biology vigorously defends our weight, and only a small minority have long term sustained success with lifestyle alone. Obesity treatment provides control of this chronic disease, not a cure.
BARRIER: Weight bias and stigma.
Health care providers all too often believe that it is a person’s fault for having elevated weight, and simply a matter of will power. Insurance often lists obesity as a ‘lifestyle problem’. People who struggle with weight may have internalized weight bias (ie feeling negatively about themselves due to their weight struggles).
Strategies to overcome this barrier: Again, understanding the biology of obesity, and that it is a chronic disease and not a lifestyle issue, are key. The Harvard implicit weight bias test can be taken by anyone, and can be very eye-opening to identify biases. Insurance companies need to reclassify weight management medication as a chronic disease treatment.
BARRIER: News/social media misinformation.
Misinformation through these outlets can misshape expectations for how much weight loss can be expected, and how fast this should occur (eg exceptional success testimonials become the expectation). Potential side effects can be overblown and cause much fear amongst people with obesity and their health care providers.
Strategies to overcome this barrier: People and their health care providers need to be supported in finding reputable and trustworthy information. Doctors should understand the clinical trial data and postmarketing reports, and provide accurate information on benefits and risks of treatment. Reputable medical news agencies and general public sites are out there! (it’s one big reason why I’m dedicated to writing this blog 🙂
BARRIER: Side effect concerns.
People struggling with their weight, and their health care providers, are concerned about common and rare potential side effects. They may not have found a reputable place to get this information. When postmarketing case reports come out, they often hit headlines in the media, engendering (potentially disproportionate) fear.
Strategies to overcome this barrier: Any doctor prescribing any medication must always go through the side effect potential with each patient, both common and rare. Gastrointestinal side effects are the most common with many weight management medications, which can often be mitigated with preemptive strategies (eg talking about eating smaller meals, listening to the fullness sense that medication can provide, and mindful eating, starting at the time of prescribing). Allied health (pharmacists, dietitians, nurses) can be instrumental to support patients through titration of these medications. Health care providers need to keep their patients informed and updated as knowledge evolves.
BARRIER: ACCESS.
This one is probably the biggest barrier to treatment with obesity medication. There is most often no public coverage, and private insurance coverage is often poor. If there is insurance coverage, oodles of paperwork can be time consuming, and coverage can be limited and inflexible. Doctors may assume that a person without insurance can’t afford treatment, rather than ask them if they can. As blogged previously, socioeconomic and ethnic disparities to access exist. Payors are reluctant to cover treatment due to cost and the number of the people that may qualify.
Strategies to overcome this barrier: Medications need to be available at lower cost (which will hopefully occur as more highly effective medications emerge as competitors on the market). More streamlined processes for insurance coverage are needed. Insurance needs to cover dosing with flexibility, so that each individual can take the dose that is best for them. There needs to be more approvals for public reimbursement of obesity medication, which will start with covering specific health conditions associated with elevated weight (recent exciting news from USA on this here). ALL of us need to advocate for all of the above!!
Check me out on X/twitter! @drsuepedersen
Share this blog post using your favorite social media link below!
www.drsue.ca © 2024
