Weight loss medicines underutilized by veterans

Despite the availability of new weight management medications and several clinical guidelines recommending their use as part of a comprehensive treatment plan for obesity, a new study has found that their use is extremely low (about one percent) among eligible Veterans.

Being female, having higher body mass index (BMI), obstructive sleep apnea, osteoarthritis, depression, low back pain and alcohol abuse was associated with greater likelihood of using these medications. However, being over the age of 65, Hispanic race/ethnicity and required copayments was associated with lower odds of their use.

Obesity is a chronic disease that compromises quality of life, increases healthcare costs, and is a risk factor for and increases morbidity from diabetes, depression, hypertension, coronary heart disease, stroke, osteoarthritis, obstructive sleep apnea (OSA) and several cancers. In 2017, the prevalence of obesity among the Veterans Health Administration (VA) patient population was 41 percent while 37 percent were overweight.

To address this issue, every VA facility now offers MOVE!, a comprehensive behavioral weight management program, to any veteran who is overweight or obese. MOVE! has evolved into the largest health-care based weight management program in the country. Any veteran who is engaged in MOVE! or a similar behavioral weight management program is eligible to receive weight management medication.

"Of the more than 150,000 participants in MOVE!, only about one percent receive weight management medication," said Varsha G. Vimalananda, MD, MPH, from the Center for Healthcare Organization & Implementation Research at the Edith Nourse Rogers Memorial Veterans Affairs Medical Center.

According to the researchers, this low rate of use is also similar to non-VA settings where less than two percent of potentially eligible patients in the general population are treated with these medications. "The comparably low rates of use of medicine in and outside the VA are surprising. Insurance coverage is a major barrier to use outside the VA, but is a much lesser issue in VA, where veterans can receive them at no or relatively low out-of-pocket cost," explained Vimalananda, an assistant professor of medicine at Boston University School of Medicine.

The researchers believe clinician or patient barriers beyond insurance drive underuse of these medications for Veterans as well as the general population and that additional research is needed to better understand these obstacles.

These findings appear online in the journal Obesity.