Willingness to Take Weight Loss Medication Among Obese Primary Care Patients
Discussion
In our study, we found that a large proportion (75%) of primary care patients with at least moderate obesity were willing to take a daily weight loss medication if their doctor recommended it. After full adjustment, men, those with lower quality of life (QOL), and patients with diabetes were more likely to pursue weight loss pharmacotherapy than their counterparts. Moreover, QOL appeared more important than comorbid diagnoses in contributing to whether patients would consider taking a weight loss medication. Most patients expected to lose more than 10% of their weight to make taking a daily medication worthwhile.
Few studies have examined patients’ willingness to take a medication to lose weight. Tan et al [11] found that only about half of their surveyed outpatients were likely to take a medication to lose weight; however, approximately a quarter of the patients in that study were of normal BMI. In contrast, our study interviewed patients with at least a BMI of 35 kg/m2 and the majority of these patients reported a willingness to take a weight loss medication. Nevertheless, patients appear to have unrealistic expectations of the weight loss potential of pharmacotherapy. Only a minority of patients in our study would be willing to take a weight loss medication if the weight loss was no more than 10%, a level that is more consistent with the outcomes achievable in most clinical trials of weight loss medications [12]. Prior studies have also shown that patients often have unrealistic weight loss expectations and are unable to achieve their ideal body weight using diet, exercise, or pharmacotherapy [13,14]. Doyle et al found that percentage of weight loss was the most important treatment attribute when considering weight loss pharmacotherapy when compared to cost, health improvements, side effects, diet and exercise requirements, and method of medication administration [8]. Thus it is important to educate patients on realistic goal setting and the benefits of modest weight loss when considering pharmacotherapy. The weight loss preferences expressed in our study may also influence the weight loss outcomes targets pursued in pharmaceutical development. Interestingly, after full adjustment, BMI did not correlate with willingness to take a weight loss medication. Given that all patients in our study had a BMI of ≥ 35 kg/m2, this may imply that variations beyond this BMI threshold did not significantly affect a patient’s willingness to use pharmacotherapy. In contrast, weight-related QOL was an important correlate.
Men were slightly more likely than women to be willing to take a weight loss medication, which is interesting since men have been shown to be less likely to participate in behavioral weight loss programs and diets [15]. One reason may be that many weight loss programs are delivered in group settings which may deter men from participating. Whether this hypothetical willingness to undergo pharmacotherapy would translate to actual use is unclear, especially since there are barriers to pharmacotherapy including out-of-pocket costs. In a prior study in the United Kingdom, women were more likely to have reported prior weight loss medication use than men [16].
Our study did not find differences in willingness to pursue weight loss medication by race or educational attainment. This is consistent with our prior work demonstrating that racial and ethnic minorities were no less likely to consider bariatric surgery if the treatment were recommended by their doctor [9]. However, our other work did suggest that clinicians may be less likely to recommend bariatric surgery to their medically eligible minority patients as compared to their Caucasian patients. Whether this may be the case for pharmacotherapy is unclear since this was not explicitly queried in our current study [9].
Our study also found that patients with diabetes but not other comorbidities were more likely to consider weight loss medication after adjusting for QOL. This may reflect a stronger link between diabetes and obesity perceived by patients. Our result is consistent with our earlier data showing that diabetes but not other comorbid conditions was associated with a higher likelihood of considering weight loss surgery [9]. Nevertheless, having diabetes contributed only modestly to the variation in patient preferences regarding pharmacotherapy as reflected by the trivial change in model C-statistic when diabetes status was added to the model.
