Aurora, CO—For the nearly 40% of Americans who are obese, “weight-loss medications are the intermediate choice between lifestyle programs and bariatric surgery in both effectiveness and cost.”

Yet, despite that and guidelines calling for the use of prescription drugs to treat BMI higher than 30, an article in the journal Obesity decries the underuse of the medications.

University of Colorado, Anschutz Medical Campus–led researchers sought to examine the prescribing patterns and use of antiobesity medications in a large cohort of patients, using data from electronic health records.

Researchers obtained pharmacy- and patient-level electronic health-record data on more than 2.2 million adults eligible for weight-loss medications from eight healthcare organizations across the country.

Results indicate that 29,964 patients—1.3% of the total cohort—filled at least one weight-loss medication prescription. Those filling prescriptions were 82.3% female, with a median age of 44.9 years and median BMI of 37.2 kg/m2.

The study notes that phentermine accounted for 76.6% of all prescriptions, with 51.7% of prescriptions filled for 120 days or more and 33.8% filled for 360 days or more.

“There was an increase of 32.9% in medication days for all medications in 2015 compared with 2009,” the authors write. “Higher prescription rates were observed in women, black patients, and patients in higher BMI classes.”

The study also points out that, of 3,919 providers who wrote at least one filled prescription, 23.8% were “frequent prescribers” who wrote 89.6% of all filled prescriptions.

The authors conclude that weight-loss medications are rarely prescribed to eligible patients.

“Phentermine accounted for >75% of all medication days, with a majority of patients filling it for more than 4 months,” they add. “Less than one-quarter of prescribing providers accounted for approximately 90% of all prescriptions.”

In an accompanying commentary, William H. Dietz, MD, PhD, of The George Washington University, discusses the importance of resolving the “treatment conundrum.”

“Resolution of the conundrum will require the integration of multiple strategies, including empowerment of people with obesity to demand appropriate and effective care, overcoming bias and stigmatization, documentation of obesity, shared decision-making about care with competent providers  adherence to a standard of care and inclusion of pharmacotherapy in health plan formularies,” Dr. Dietz suggests.

“The most effective strategy may be to recognize that obesity is a disease and needs to be treated as such and to hold providers accountable for the care that they provide or don’t,” he concludes.

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