Adults with lower socioeconomic status more likely to use obesogenic medications
Adults with a lower socioeconomic status were more likely to use obesogenic medications, even after adjusting for comorbidity and medication burden, according to findings published in The Lancet Regional Health Americas.
One in five adults are prescribed obesogenic medications, Healio previously reported. Yet, the Endocrine Society Clinical Practice Guidelines recommend that physicians avoid prescribing obesogenic medications to patients with overweight or obesity.
“Our study demonstrated substantial gaps between guideline recommendations and the real-world use of obesogenic medications and anti-obesity medications in the U.S.,” Beini Lyu, MD, PhD, a research associate in the department of epidemiology at the Johns Hopkins Bloomberg School of Public Health, told Healio.
In a population-based study, Lyu and colleagues used data from the U.S. National Health and Nutrition Examination Survey (NHANES) to analyze medications prescribed to 10,673 adults with overweight or obesity from 2009 to 2018. The researchers calculated a composite socioeconomic status (SES) score of zero points (high), one point (intermediate) and two or more points (low) based on the participants’ education, household income and insurance status.
Lyu and colleagues reported that 20% of participants had a low SES. These individuals were more likely to be older, female, Mexican American or Black and have a higher BMI (mean 29.7 kg/m²).
Among the study cohort, 37.7% of participants used obesogenic medications. Use of these medications was higher among people with lower SES, independent of demographic characteristics, prescription medication burden and comorbidities (OR = 1.3; 95% CI, 1.2-1.5), according to the researchers. Common obesogenic medications that were prescribed included beta-blockers (18.2%; 95% CI, 17-19.3), antidiabetic medications (10.7%; 95% CI, 9.9-11.5) and antidepressants/antianxiety drugs (9.3%; 95% CI, 8.6-10.1). Overall, Lyu and colleagues reported that 40% of adults with overweight or obesity took at least one obesogenic medication, even when non-obesogenic alternatives were available.
Factors such as limited access to health care, medication cost and differential quality of care can drive differences in obesogenic medication use by SES, Lyu said.
Meanwhile, utilization of anti-obesity medications among all adults remained very low, at 0.5%. Use of anti-obesity medications was lowest among adults with lower SES (0.27%) compared with those with intermediate (0.71%) and high (0.65%) status. Several factors may have contributed to low utilization, according to the researchers, including a limited knowledge of recommendations for obesity management, obesity-related bias and stigma, limited resources and other demanding chronic conditions.
“Our results suggest that clinicians need to carefully screen patients’ medications for those that may cause weight gain and increase prescription of anti-obesity medications, especially among adults living with low SES,” Lyu said.
Perspective
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A recent study by Lyu and colleagues used data from NHANES to look at the association of the use of obesogenic medications, anti-obesity pharmacotherapy and SES.
The Endocrine Society Clinical Practice Guidelines recommend the avoidance of medications that may cause weight gain (eg, obesogenic medications) in individuals with overweight or obesity. Obesity disproportionately affects people with lower SES. This study showed that obesogenic medications were more frequently prescribed in people with lower SES. It also highlighted the fact that independent of SES, anti-obesity medications are underutilized for the treatment of the disease of obesity. Irrespective of SES, less than 1% of adults with obesity were prescribed anti-obesity pharmacotherapy.
Given that obesity is more prevalent in people of lower SES, this study highlights a large gap in treatment that is in urgent need of addressing so we can reduce the burden of the disease of obesity in our country. This article also highlights the need for urgent changes in legislation across the country to make coverage of anti-obesity pharmacotherapy a standard benefit of all insurance plans, both public and private. Some of the prescribing trends can be accounted for due to the high cost and lack of coverage for anti-obesity medications and the lower cost of obesogenic medications. This tendency toward a lower cost of medications such as sulfonylureas, for example, and higher cost of GLP-1 agonists for obesity or diabetes highlights the issue at hand.
We need to do our best to recognize the burden of obesity and pick whatever medication tools we have at our disposal to choose the least weight promoting and most weight reducing medication treatment plan for patients with obesity in every encounter as we are medically able. A weight-centric approach to pharmacotherapy should be something we consider as we balance the risk and benefit of medication use.
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