Original Research

Willingness to Take Weight Loss Medication Among Obese Primary Care Patients

Journal of Clinical Outcomes Management. 2017 March;24(3)

Author(s):

References

1. Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of obesity among adults: United States, 2011–2012. NCHS Data Brief 2013;(131):1–8.

2. Jensen MD, Ryan DH, Apovian CM, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. J Am Coll Cardiol 2014;63(25 Pt B):2985–3023.

3. Hauptman J, Lucas C, Boldrin MN, et al. Orlistat in the long-term treatment of obesity in primary care settings. Arch Fam Med 2000;9:160–7.

4. Kakkar AK, Dahiya N. Drug treatment of obesity: current status and future prospects. Eur J Intern Med 2015;26:89–94.

5. Allison DB, Gadde KM, Garvey WT, et al. Controlled-release phentermine/topiramate in severely obese adults: a randomized controlled trial (EQUIP). Obesity (Silver Spring). 2012;20:330–42.

6. Fabricatore AN, Wadden TA. Obesity. Annu Rev Clin Psychol 2006;2:357–77.

7. Cheung BM, Cheung TT, Samaranayake NR. Safety of antiobesity drugs. Ther Adv Drug Saf 2013;4:171–81.

8. Doyle S, Lloyd A, Birt J, et al. Willingness to pay for obesity pharmacotherapy. Obesity (Silver Spring) 2012;20:2019–26.

9. Wee CC HK, Bolcic-Jankovic D, Colten ME, et al. Sex, race, and consideration of bariatric surgery among primary care patients with moderate to severe obesity. J Gen Intern Med 2014;29:68–75.

10. Kolotkin RL, Crosby RD, Kosloski KD, Williams GR. Development of a brief measure to assess quality of life in obesity. Obes Res 2001;9:102–11.

11. Tan DZN, Dennis SM, Vagholkar S. Weight management in general practice: what do patients want? Med J Aust 2006;185:73–5.

12. Yanovski SZ, Yanovski JA. Long-term drug treatment for obesity: a systematic and clinical review. JAMA 2014;311:74–86.

13. Foster GD, Wadden TA, Vogt RA, Brewer G. What is a reasonable weight loss? Patients’ expectations and evaluations of obesity treatment outcomes. J Consult Clin Psychol 1997;65:79–85.

14. Fabricatore AN, Wadden TA, Womble LG, et al. The role of patients’ expectations and goals in the behavioral and pharmacological treatment of obesity. Int J Obes (Lond) 2007;31:1739–45.

15. Robertson C, Archibald D, Avenell A, et al. Systematic reviews of and integrated report on the quantitative, qualitative and economic evidence base for the management of obesity in men. Health Technol Assess 2014;18:1–424.

16. Thompson RL, Thomas DE. A cross-sectional survey of the opinions on weight loss treatments of adult obese patients attending a dietetic clinic. Int J Obes Relat Metab Disord 2000;24:164–70.

17. Kolotkin RL, Crosby RD, Williams GR. Health-related quality of life varies among obese subgroups. Obes Res 2002;10:748–56.

18. Wee C, Davis R, Chiodi S, et al. Sex, race, and the adverse effects of social stigma vs. other quality of life factors among primary care patients with moderate to severe obesity. J Gen Intern Med 2015;30:229–35.

From Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA.

Abstracts

Objective: To identify patient factors associated with willingness to take daily weight loss medication and weight loss expectations using these medications.
Methods: A random sample of 331 primary care patients aged 18–65 years with a BMI ≥ 35 kg/m ² were recruited from 4 diverse primary care practices in Boston, MA. We conducted telephone interviews and chart reviews to assess patients’ willingness to take a weight loss medication and their expectations for weight loss. We used sequential logistic regression models to identify demographic, clinical, and quality of life (QOL) factors associated with this willingness.
Results: Of 331 subjects, 69% were women, 35% were white, 35% were black, and 25% were Hispanic; 249 (75%) of patients were willing to take a daily weight loss medication if recommended by their doctor but required a median weight loss of 15% to 24%; only 17% of patients were willing to take a medication for ≤ 10% weight loss. Men were significantly more willing than women (1.2 [95% CI 1.0–1.4]). Diabetes was the only comorbidity associated with willingness to consider pharmacotherapy (1.2 [1.0–1.3]) but only modestly improved model performance (C-statistic increased from 0.59 to 0.60). In contrast, lower QOL, especially low self-esteem and sex life, were stronger correlates (C-statistic 0.72).
Conclusion: A majority of obese primary care patients were willing to take a daily weight loss pill; however, most required more than 10% weight loss to consider pharmacotherapy worthwhile. Poor QOL, especially low self-esteem and poor sex life, were stronger correlates than having diabetes.

Key words: obesity; primary care; weight loss medication.

In the United States, obesity continues to be unrelentingly prevalent, affecting more than one-third of adults (34.9%) [1]. This statistic has ominous implications when considering that obesity is a risk factor for numerous chronic diseases, such as coronary heart disease, diabetes, sleep apnea, osteoarthritis, and some types of cancers [2]. Moreover, it is associated with increased risk of all-cause and cardiovascular disease mortality. Promisingly, an initial 5% to 10% weight loss over 6 months has been associated with improvement in LDL, HDL, triglycerides, glucose, hemoglobin A1C, diabetes risk, blood pressure, and medication use [2]. Therefore, although patients may not be able to achieve their ideal body weight or normal BMI, modest weight loss can still have beneficial health effects.

Weight loss medications are effective adjunctive therapies in helping patients lose up to 10% of their body weight on average when combined with diet and exercise [3–5]. There are currently 5 medications approved by the Food and Drug Administration for long-term use for weight loss: orlistat, lorcaserin, phentermine-topiramate, bupropion-naltrexone, and liraglutide. Despite their proven efficacy, there are barriers to initiating a long-term weight loss medication. Insurance reimbursement is limited for these medications, thus resulting in high out-of-pocket cost for patients that they may be unable or unwilling to pay [6]. There may also be safety concerns given that several weight loss medications, including fenfluramine, sibutramine, and rimonabant, have been withdrawn from the market because of adverse effects [7]. Thus, in deciding whether to initiate a pharmacologic weight loss regimen, patients must believe that the weight loss benefits will exceed the potential risks.