Sex, race, insurance type predict youth access to obesity drugs
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Key takeaways:
- Female sex, severe obesity, more comorbidities and older age were all linked to higher odds of youth obesity medication prescription.
- Black and Hispanic youths were less often prescribed vs. white youths.
SAN ANTONIO — Researchers identified several factors associated with likelihood of obesity drug prescription among youths, including female sex, higher obesity severity, having more comorbidities and older age, a speaker reported.
In addition, Black and Hispanic youths, who comprised a larger portion of the overall cohort than white youths, were less often prescribed obesity medicine, according to data presented at ObesityWeek.
“Pharmacological approaches to pediatric obesity have emerged as safe and effective treatment options, complementing lifestyle interventions and behavioral modifications. Understanding the predictors and medication prescription is crucial for several reasons,” Sophie N. Ravanbakht, PhD, a postdoctoral associate in the department of population health sciences and Duke Center for Childhood Obesity Research, said during a presentation. “As the landscape of obesity treatment evolves, understanding the characteristics of patients prescribed weight-loss medications becomes crucial for tailoring effective interventions. This study aims to bridge the knowledge gap by examining a wide range of potential predictors of medication prescription for obesity treatment in youth aged 5 to 18 years.”
Ravanbakht and colleagues conducted retrospective analysis of 4,167 patients with 19,707 visit records to the Duke Children’s Healthy Lifestyles Clinic, a tertiary care obesity treatment center in Durham, North Carolina, from January 2013 to February 2023.
Current obesity treatment components at this tertiary clinic included motivational interviewing, intensive health behavior and lifestyle treatment, obesity pharmacotherapy and metabolic or bariatric surgery.
The main outcome was prescription of medications for the purpose of weight loss. Overall, 21.22% of patients received topiramate (Topamax, Janssen), 3.87% phentermine (Lomaira, KVK-Tech), 0.54% orlistat (Xenical, Roche), 79.24% metformin and 0.15% lisdexamfetamine. GLP-1 receptor agonists were not included in the analysis.
Predictors of obesity medication prescription included child age, sex, race/ethnicity, obesity severity, number of comorbidities, insurance type and number of visits, and mixed-effects logistic regression was used to identify which predictors were significantly associated with medication prescription.
The researchers reported that children prescribed pharmacotherapy for weight loss were on average older compared with those not prescribed (14.8 years vs. 11.4 years).
White patients consisted of a larger proportion of those prescribed obesity medication compared with the overall cohort (45.7% vs. 18.8%), whereas Black and Hispanic patients represented 40.2% and 36.5% of the total cohort and 18.9% and 23.7% of the prescribed cohort, respectively.
The majority of patients in the overall cohort (72.7%) and of those prescribed obesity medication (70.7%) were on public insurance, according to the presentation.
The researchers noted a higher proportion of children with more severe obesity were prescribed obesity medication (14.3% with class I obesity vs. 61.2% with class III obesity).
Moreover, girls were more likely compared with boys to be prescribed obesity medication (OR = 1.51; 95% CI, 1.12-2.04) and those who received a prescription were also more likely to have more comorbidities compared with the overall cohort (OR with two comorbidities = 1.35; 95% CI, 1.05-1.73; OR with three comorbidities = 1.53; 95% CI, 1.1-2.12).
“Our work identified key predictors for obesity medication prescriptions among pediatric patients in a tertiary care clinic. We found that certain factors were associated with higher odds of receiving a prescription, including being female, having greater obesity severity, presenting with multiple comorbidities, being older at your first clinic visit, and having a higher frequency of total clinic visits,” Ravanbakht said during the presentation. “These findings have important clinical implications. By recognizing these predictors, health care providers can better identify potential prescribing patterns and barriers, enabling them to tailor future interventions to promote more equitable access to obesity treatment for youth.
“As of Aug. 1, 2024, North Carolina Medicaid will now cover GLP-1s. So we plan to update these analyses to include these popular medications,” she said. “Additionally, we aim to explore the underlying reasons for demographic and socioeconomic disparities in prescription patterns. This understanding may eventually help providers recognize which patients are more or less likely to receive a prescription, ultimately optimizing the use of obesity medications to support better health outcomes in this population.”
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Ravanbakht SN, et al. Oral-003. Presented at: ObesityWeek; Nov. 3-6, 2024; San Antonio.
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