Racial, ethnic minorities less likely to use weight loss medications to manage obesity

Key takeaways:

• Lower odds of anti-obesity medication use were tied to unemployment and lower education status.
• Researchers highlighted shared decision-making and ethnicity-specific BMI thresholds when addressing disparities.

Use of weight loss medications appeared to be significantly lower among those from certain racial and ethnic minority groups, results from a cross-sectional study published in Journal of Racial and Ethnic Health Disparities revealed.

The analysis showed a disparity gap compared with white individuals ranging from 30% to 64% lower odds of using obesity-management medications among Asian, Black and Hispanic individuals that could not be fully accounted for when adjusting for other socioeconomic factors, including income, education and health insurance coverage.

“Our findings suggest that people with obesity from racial and ethnic minority backgrounds may face barriers to obtaining medications to treat obesity,” Kimberly D. Narain, MD, MPH, PhD, DABOM, an assistant professor-in-residence at the University of California, Los Angeles (UCLA) David Geffen School of Medicine, said in a press release.

Weight loss medications have shown the potential to significantly reduce obesity prevalence and save lives, but their out-of-pocket costs and limited coverage may increase racial disparities.

In the cross-sectional study, Narain and Christopher Scannell, MD, PhD, from the UCLA David Geffen School of Medicine, examined several years of data from the Medical Expenditure Panel Survey to determine differences in weight loss medication usage across diverse populations.

Participants (n = 91,107) included those with obesity (68%) or those with overweight and one or more weight-related condition (32%).

The analysis examined all FDA-approved medications to treat obesity during the study period, with liraglutide and phentermine being the most frequently used.

Researchers determined an unadjusted use rate of 0.34% (95% CI, 0.17%-0.68%) among Asian individuals, 0.74% (95% CI, 0.57%-0.95%) among Hispanic individuals, 0.81% (95% CI, 0.65%-1%) among Black individuals and 1.2% (95% CI, 1.04%-1.39%) among White individuals

An analysis adjusted for certain socioeconomic factors showed that Asian (adjusted OR = 0.36; 95% CI, 0.16-0.77), Black (aOR = 0.51; 95% CI, 0.39-0.68) and Hispanic individuals (aOR = 0.7; 95% CI, 0.49 to 0.98) had significantly lower odds of using weight loss medications vs. white individuals.

Higher odds of weight management medication use corresponded with:

• higher BMI (aOR = 5.82; 95% CI, 3.32-10.2);
• female gender (aOR = 1.63; 95% CI, 1.31-2.03);
• having diabetes (aOR = 5.26; 95% CI, 4.27-6.49) and
• having two or more weight-related conditions (aOR = 1.53; 95% CI, 1.17-2).

In comparison, the analysis showed lower odds of use to be associated with unemployment (aOR = 0.68; 95% CI, 0.53-0.87) and lower education status (aOR = 0.56; 95% CI, 0.34 to 0.93), but “racial and ethnic differences persisted despite controlling for these factors,” Narain and Scannell noted.

The researchers added that the likelihood of use among Asian individuals lowered by an additional 33% (aOR = 0.24; 95% CI, 0.11-0.52) when they expanded the study population to include individuals meeting weight loss medication utilization criteria using Asian-specific BMI criteria.

The researchers suggested several possible contributors behind the findings, such as gaps in physician knowledge regarding Asian-specific BMI, differences in health insurance quality and less engagement in patient-centered communication among diverse populations.

“It is... important that clinically-eligible patients be engaged in shared decision-making around obesity-management medication use,” they wrote. “Physicians should familiarize themselves with ethnicity-specific BMI thresholds as well as the general cost profile and financial support resources for these medications.”

Narain and Scannell acknowledged that using BMI, “a flawed measure of adiposity among certain ethnic groups,” to determine utilization eligibility as a study limitation. They also were unable to determine causality due to the analysis’ design.

“It will be important to gather information from racially and ethnically diverse individuals regarding their perspectives on using medications to treat obesity,” Narain said in the release. “We need more investigation into the role of other potential drivers of these differences that we didn’t consider in this study, such as health insurance benefit design.”

References:

People from some racial and ethnic groups may face barriers to obtaining obesity medications. Available at: https://www.uclahealth.org/news/release/people-some-racial-and-ethnic-groups-may-face-barriers. Published Dec. 18, 2024. Accessed Dec. 30, 2024.
Narain K, Scannell C. J Racial Ethn Health Disparities. 2024;doi:10.1007/s40615-024-02248-x.