Greetings,
Despite the promise of increasingly effective pharmacotherapy for obesity, the rate of prescriptions for weight-loss medications in the US is surprisingly low. A study of over 2.2 million adults from 2009 to 2015 found that the rates of rates of prescriptions for anti-obesity medications (AOMs) ranged from 0.6% to 2.9% of eligible patients. The study results also demonstrated an uneven distribution of these prescriptions. Of those providers who prescribed AOMs, the majority (72.9%) prescribed them to five or fewer patients, and only a small proportion (8.3%) of providers prescribed to 21 or more patients. The prescribers who wrote the most prescriptions wrote 89.6% of all filled prescriptions in the study.
The low rate of prescriptions of AOMs may date to the early history of obesity treatment with pharmacotherapy. In the early to mid-1990s, FDA approved three drugs -- phentermine, fenfluramine, and dexfenfluramine -- to treat obesity. In particular, providers began to prescribe a combination known as “fen-phen,” with the “fen” referring to fenfluramine or dexfenfluramine and the “phen” referring to phentermine. In 1996, doctors wrote a total of 18 million monthly prescriptions for either fenfluramine or phentermine. By 1997, however, the trend of providers prescribing this drug combination ended abruptly when multiple cases of adverse events were recorded. Clinicians identified cases of valvular heart disease and unusual valvular morphology in 24 women treated with the combination of fenfluramine-phentermine for an average of 12 months.
Following these adverse events, the FDA issued a public health advisory for fen-phen and requested that health care providers send in patient information on any effects from taking the combination of drugs. The FDA received information on 113 cases in addition to the original 24 publicly reported cases; according to a CDC MMWR report, “Of these 113 cases, two (2%) used fenfluramine alone; 16 (14%), dexfenfluramine alone; 89 (79%), a combination of fenfluramine and phentermine; and six (5%), a combination of all three drugs. None of the cases used phentermine alone.” Further studies demonstrated an association between fen-phen use and increased risk of cardiac-valve regurgitation and pulmonary hypertension, especially if the drugs were taken for more than three months. A likely mechanism that could account for how fenfluramine and dexfenfluramine contribute to these cardiac conditions is that they may target serotonin receptors on heart valves, leading to fibrosis. As a result of these findings, fenfluramine and dexfenfluramine were voluntarily taken off of the market.
The adverse effects of these drugs recognized 25 years ago may have established a lasting sense of mistrust among providers when it comes to obesity medications. A recent survey of providers found that only 4% of primary care physicians (PCPs) felt that weight loss medications were safe, whereas 60% of PCPs reported that a concern of adverse events was a barrier to prescribing these medications. The survey also found that 76% of all PCPs did not prescribe weight loss medications for long-term weight loss therapy, and over half (58%) of PCPs reported “negative” and “very negative” perceptions of pharmacotherapy as a treatment for obesity.
In analyses that STOP published from the 2016 and 2017 DocStyles surveys, 31% of healthcare providers said they did not prescribe drug therapy for obesity, and only 8% of healthcare providers surveyed could correctly identify the guideline-recommended thresholds to initiate and continue pharmacotherapy for obesity. Earlier data from 2009-2015 suggest that the rates of obesity medications reportedly prescribed by respondents to the DocStyles surveys are overestimates.
Despite the problematic past of some obesity medications, many important advances have been made in the field of pharmacotherapy. New medications such as semaglutide have proven safe and effective, with a low incidence of severe side effects. Nonetheless, many providers still believe that obesity medications are unsafe, despite substantial research that has proven otherwise. Moving forward, it is important that providers are educated about the safe and effective treatments for obesity that are available.
Thanks,
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Upcoming Events
Nov 1-3: AICR Research Conference
Nov 1-5: ObesityWeek®
Nov 4: COPE Webinar Series Begins
Nov 10: TFAH Webinar
Nov 12-13: OMA Course
Dec 15: COPE Webinar on Bariatric Surgery
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Announcements
Dr. Bill Dietz recognized by Expertscape
CDC Childhood Obesity Research Demo
ECPO Launches First Image Bank
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Redstone Global Center for Prevention and Wellness
Congratulations to the Redstone Center's Chair Dr. Bill Dietz for being recognized as an expert in health education by Expertscape. Expertscape objectively ranks people and institutions by their expertise in more than 29,000 biomedical topics. Dr. Dietz was placed in the top 0.1% of scholars writing about Health Education over the past 10 years, a level that Expertscape labels as "World Expert." Expertscape announced the world experts as part of National Health Education week, October 19-23, 2021.
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Register for the 2021 AICR Virtual Research Conference
The 27 th American Institute for Cancer Research (AICR) Conference will take place virtually from November 1-3, 2021. The AICR Research Conference is a three day summit that brings researchers and health professionals together. This engaging forum focuses on the role lifestyle factors play in cancer risk, diagnosis and survivorship. It affords attendees the opportunity to stay on top of research and connect with experts in the field.
More information about the conference and a registration link can be found here.
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ObesityWeek® 2021
STOP Obesity Alliance's Research Project Director, Cristy Gallagher, will be presenting our most recent research on obesity care coverage by State Employee Health Plans during ObesityWeek. The oral presentation "Trends in Obesity Treatment Coverage in State Employee Health Plans 2017-2021" will be on November 5th at 8:30 AM ET, followed by a live Q&A at 8:40 AM ET. You must be registered for ObesityWeek to attend.
The Obesity Care Advocacy Network (OCAN) will be hosting a booth in the ObesityWeek exhibit hall. The booth will open on October 26 for ObesityWeek registrants. OCAN will also be hosting an OCAN action center, where individuals can contact their representatives to take action on the Treat and Reduce Obesity Act (TROA), and the Obesity Care Now campaign. Email OCAN@fgh.com if you have any questions.
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COPE's 10th Anniversary Events Continue
CULINARY NUTRITION WITH THE 3 C’S: COOKING SKILLS, CURRICULUM AND CULTURAL FOODWAYS
4-part Virtual Series begins Wednesday, November 3
Join COPE for an in-depth 4-part workshop series in culinary nutrition that offers practical, every day, natural cooking skills as well as a deeper exploration into the history, evolution, and health aspects of specific heritage diets. Explore different cultural foodways and apply practical knowledge with clients to help them adjust their diets to allow them to continue to cook and consume their favorite foods while meeting their personal health needs. Register for individual workshops, or all 4! Continuing Education credit awarded for participation.
Learn more and register here.
December 15, 12-1pm ET
Caroline M. Apovian, MD, FACP, FTOS, DABOM is Co-Director of the Center for Weight Management and Wellness (CWMW) in the Division of Endocrinology, Diabetes, and Hypertension at Brigham and Women’s Hospital and a member of the faculty at Harvard Medical School and has held a position at the forefront of the obesity and nutrition fields for over thirty years. Dr. Apovian will present a practical approach for the early recognition of weight regain in post-bariatric surgery patients, which can lead to more effective and timely treatment.
Learn more and register here.
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TFAH Webinar: State of Obesity 2021
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Register for OMA's Last Fundamentals of Obesity Treatment Course in 2021
Are you new to obesity medicine? Join OMA Nov. 12-13 for a two-day course offering introductory education about the evidence-based approaches for evaluating, diagnosing, and treating obesity in a clinical setting. Plus, earn 9.5 CME/CE.
Learn more and register here.
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CDC's Childhood Obesity Research Demonstration 3.0
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ECPO Launches Image Bank
The European Coalition for People Living with Obesity (ECPO) have launched Europe's first image bank of living with overweight and obesity. ECPO have collaborated with 12 patient organizations across Europe, and almost 100 models from all ages and backgrounds to provide positive "people first" imagery. With almost 1,000 images of adults, adolescents, children and families in everyday scenarios, our hope is for the media and press to take the opportunity to begin using these images when reporting on obesity in Europe.
View the image bank here.
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