TOPLINE:

Among patients with overweight or obesity and obesity-related comorbidities, use of antiobesity medications increased substantially after the American Medical Association (AMA) declared obesity a chronic disease in 2013 and accelerated after semaglutide was approved for chronic weight management in 2021. The rates of metabolic and bariatric surgery (MBS) have remained stable since 2013.

METHODOLOGY:

• Researchers conducted a cohort study using the All of Us database to evaluate trends in the use of antiobesity medications and MBS among patients with obesity or overweight and related comorbidities from 2003 to 2023.
• They included 208,099 patients (mean age, 59.3 years; 64.2% female) with obesity (BMI ≥ 30) or overweight (BMI ≥ 27) and at least one obesity-related comorbidity for the antiobesity medication utilization analysis and 107,351 patients (mean age, 57.4 years; 71.3% female) with BMIs ≥ 35 for the MBS utilization analysis.
• Obesity-related comorbidities included type 2 diabetes, dyslipidemia, hypertension, sleep apnea, stroke, atrial fibrillation, coronary artery disease, and heart failure.
• Antiobesity medications included phentermine-topiramate, naltrexone-bupropion, orlistat, liraglutide, semaglutide, and tirzepatide.
• Trends in antiobesity medication prescriptions and MBS receipt were analyzed before and after the 2013 AMA declaration of obesity as a chronic disease and the 2021 approval of semaglutide in the US.

TAKEAWAY:

• Following the 2013 AMA declaration, antiobesity medication prescriptions increased by 0.31% per year and further increased by 1.42% per year after semaglutide’s approval in 2021.
• When excluding GLP-1 or glucose-dependent insulinotropic polypeptide receptor agonists, antiobesity medication prescriptions declined by 0.07% per year before 2013, increased by only 0.10% per year after 2013, and stabilized after 2021.
• MBS use declined by 0.10% per year before 2013, stabilized with a slight increase of 0.01% per year after 2013, and then declined by 0.09% per year after 2021, though this decline was not statistically significant.
• After the 2013 declaration and increasingly after the 2021 semaglutide approval, prescriptions for antiobesity medications rose substantially more for patients with BMI ≥ 40 than for those with BMI < 40; rates of MBS, which had been declining especially among those with BMI ≥ 40 before 2013, stabilized after the declaration.

IN PRACTICE:

“The 2013 declaration was associated with increased receipt of antiobesity medication prescriptions, and the approval of semaglutide in 2021 accelerated that increase. Meanwhile, the declaration stopped the decline in MBS use, which increased slightly after 2013,” the authors of the study wrote.

“These findings highlight the impact of policy and the introduction of new drugs on obesity treatment, with new drugs having a greater impact,” they added.

SOURCE:

The study was led by Olajide A. Adekunle, Center for Value-Based Care Research, Primary Care Institute, Cleveland Clinic, Cleveland. It was published online in Obesity.

LIMITATIONS:

Changes in the identified obesity population — driven by whether BMI was recorded and by shifts in patient characteristics — could bias estimated treatment rates. The race or ethnicity distribution did not reflect the US population, limiting generalizability. Additionally, the study did not capture data on antiobesity medication use obtained outside traditional healthcare settings, such as retail pharmacies or telehealth.

DISCLOSURES:

The study received no specific funding. One author declared receiving consulting fees from the Blue Cross Blue Shield Association outside the submitted work.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.