From Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA.
- 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%) . 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 . 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 . 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 . 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 . Thus, in deciding whether to initiate a pharmacologic weight loss regimen, patients must believe that the weight loss benefits will exceed the potential risks.