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Will Physicians Ever Adopt Obesity Drugs?

W. Timothy Garvey, MD; Christine Wiebe, MA | March 14, 2018 | Contributor Information

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The Big Picture

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Will Physicians Ever Adopt Obesity Drugs?

W. Timothy Garvey, MD; Christine Wiebe, MA | March 14, 2018 | Contributor Information

The Big Picture

Medscape surveyed 1283 healthcare professionals who were likely to be involved in managing obese and/or overweight patients, specifically primary care physicians (PCPs), endocrinologists, obstetrician/gynecologists, nurse practitioners (NPs), and physician assistants (PAs). All groups reported seeing substantial numbers of patients with overweight and obesity, but endocrinologists see a disproportionately high number of obese patients, who are more likely to have metabolic disease.

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Complications

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Will Physicians Ever Adopt Obesity Drugs?

W. Timothy Garvey, MD; Christine Wiebe, MA | March 14, 2018 | Contributor Information

Complications

Patients with overweight and obesity are at risk for both cardiometabolic and biomechanical weight-related complications, and this is certainly what our respondents report that they are seeing in their practices. It is noteworthy that the complication burden of patients being cared for by NPs and PAs approximates that reported by PCPs and endos. Of note, all of these complications can be improved or prevented with weight loss.

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Prescribing Patterns Revealed

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Will Physicians Ever Adopt Obesity Drugs?

W. Timothy Garvey, MD; Christine Wiebe, MA | March 14, 2018 | Contributor Information

Prescribing Patterns Revealed

Despite the high rate of obesity-related complications, only 58% of healthcare professionals prescribe weight loss medications to patients who are obese or who are overweight and have comorbid conditions.

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Group Differences

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Will Physicians Ever Adopt Obesity Drugs?

W. Timothy Garvey, MD; Christine Wiebe, MA | March 14, 2018 | Contributor Information

Group Differences

Endocrinologists are much more likely to prescribe weight loss medications than are other prescriber groups, while ob/gyns are the least likely. Among primary care providers, physicians are somewhat more likely to prescribe these drugs than are NPs or PAs.

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A Range of Weight Loss Approaches

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Will Physicians Ever Adopt Obesity Drugs?

W. Timothy Garvey, MD; Christine Wiebe, MA | March 14, 2018 | Contributor Information

A Range of Weight Loss Approaches

Among those who do prescribe weight loss drugs, all groups favor lifestyle therapy consisting of diet modification and exercise to manage obesity. Fewer incorporate behavioral therapy into the lifestyle intervention. This is at odds with clinical trials showing that structured lifestyle interventions are most effective when they incorporate a reduced-calorie meal plan, an exercise prescription, and a package of behavioral interventions that are designed to increase adherence to the meal plan and physical activity.

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Setting Goals, Reaching Goals

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Will Physicians Ever Adopt Obesity Drugs?

W. Timothy Garvey, MD; Christine Wiebe, MA | March 14, 2018 | Contributor Information

Setting Goals, Reaching Goals

Among patients treated with weight loss medications, there is considerable variation in the outcomes. This variation is consistent with clinical trial data and is the reason for switching to a different medication if weight loss is less than 5% after 3 months on the full dose of the initial medication.

An open question in this survey is the definition of "goal." Often, patients expect more profound degrees of weight loss, when 5% to 15% is sufficient to improve health, reduce complications, and improve quality of life. For this reason, it is important that healthcare professionals and patients harmonize the goals of therapy at the initiation of the treatment plan.

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Setting Up Hurdles?

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Will Physicians Ever Adopt Obesity Drugs?

W. Timothy Garvey, MD; Christine Wiebe, MA | March 14, 2018 | Contributor Information

Setting Up Hurdles?

Many healthcare professionals (50%) prescribe weight loss medications only after a lifestyle intervention plan fails to achieve desired results, and 20% prescribe them upon patient request. Only 9% prescribe medications based on whether patients have obesity-related complications. The Endocrine Society's guidelines recommend the use of weight loss medications when lifestyle therapy fails, when there is weight regain following lifestyle-induced weight loss, or as an adjunct to behavioral modification to amplify adherence.

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Barriers to Improving Health

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Will Physicians Ever Adopt Obesity Drugs?

W. Timothy Garvey, MD; Christine Wiebe, MA | March 14, 2018 | Contributor Information

Barriers to Improving Health

The lack of insurance coverage for weight loss medication is a well-established impediment to making these evidence-based treatments available. As for patients' willingness to follow a weight loss plan, readiness for change is important, of course, but so is the obligation of the healthcare team to find a plan that suits the patient, one which he or she is able to follow.

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Another Untapped Option

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Will Physicians Ever Adopt Obesity Drugs?

W. Timothy Garvey, MD; Christine Wiebe, MA | March 14, 2018 | Contributor Information

Another Untapped Option

Multiple guidelines recommend bariatric surgery for patients with a BMI ≥ 40 kg/m2 or with a BMI of 35-39.9 kg/m2 plus at least one obesity-related complication, such as diabetes or hypertension. As we have already seen, respondents to this survey reported a high rate of obesity-related complications in their patients, yet even among those who prescribe weight loss medications (with varying levels of success), only 13% to 18% ever refer patients for bariatric surgery.

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The Big Surprise: Which Drugs?

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Will Physicians Ever Adopt Obesity Drugs?

W. Timothy Garvey, MD; Christine Wiebe, MA | March 14, 2018 | Contributor Information

The Big Surprise: Which Drugs?

Obesity experts often focus on the five drugs approved by the US Food and Drug Administration (FDA) for weight loss when discussing pharmacologic approaches to obesity management, but this survey shows that what happens in clinical practice can be very different from what is described in clinical guidelines. The most prescribed weight loss drug is generic phentermine, which is approved by the FDA only for short-term treatment (ie, ≤ 3 months). This is followed by off-label use of generic bupropion and generic topiramate. The five medications approved by the FDA for chronic treatment of obesity are shown next along with branded topiramate and generic naltrexone, an ingredient in one of the combination obesity drugs.

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Just Say 'No' to Bad Diet and Inactivity

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Will Physicians Ever Adopt Obesity Drugs?

W. Timothy Garvey, MD; Christine Wiebe, MA | March 14, 2018 | Contributor Information

Just Say 'No' to Bad Diet and Inactivity

A desire to stay focused on diet and exercise is the main reason why healthcare professionals avoid prescribing weight loss drugs, although they also have significant concerns about the drugs themselves. Some of them admit that they just don't know enough about these relatively new medications, especially the ob/gyns who responded to the survey.

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Learn More

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Will Physicians Ever Adopt Obesity Drugs?

W. Timothy Garvey, MD; Christine Wiebe, MA | March 14, 2018 | Contributor Information

Learn More

Using Anti-obesity Drugs: Which Drug for Which Patient?

Quick Takes: What You Need to Know About The 5 FDA-Approved Obesity Drugs

Obesity Medication

Better Education Needed

Our survey results show that healthcare professionals are more experienced with generic drugs for weight loss than they are with drugs approved by the FDA for chronic therapy on the basis of rigorous clinical trials assessing efficacy and safety. This pattern of clinical experience is similar in both physicians and advanced care professionals (NPs). We have known that many patients who could benefit from these medications may not have access to them due to cost considerations, but now we also know that there is a need for better understanding of obesity pharmacotherapy on the part of healthcare professionals.

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