Identifying Drivers and Barriers to Anti-Obesity Medication Use in Obesity Care
October 14, 2023 Posted by: Eli Lilly and Company
Most people either know someone or are personally impacted by obesity. Despite its severity and prevalence, obesity (BMI ≥ 30 kg/m2) wasn’t recognized as a disease until 2013 by the American Medical Association.
Years later, many still think the disease is related to lifestyle choices. Anti-obesity medications (AOMs) are often not discussed as an element of obesity treatment plans.
About the OBSERVE Study
People with obesity deserve access to comprehensive care, like other chronic and metabolic diseases. There’s a critical need for the healthcare community to broadly accept obesity as a treatable disease with effective pharmacological options.
That’s why we initiated the OBSERVE study in collaboration with Cerner Enviza and leading key opinion leaders to better understand the underlying reasons for obesity care limitations.
OBSERVE is a nationwide U.S. study focused on understanding AOM use. It digs into the drivers and barriers that influence obesity care and treatment to uncover the core misperceptions about obesity care. Study participants include people living with obesity, healthcare providers (HCPs) and employers, who each play a unique role in influencing obesity care.
Results Revealed Underlying Biases, Lack of Understanding That Impact Care
Bias and Misperceptioni
Results of the qualitative research, which were unveiled in late 2021, revealed underlying patterns of bias and misperception across participant groups. Many people living with obesity who participated said they don’t identify themselves with the term “obesity” and those who do, tend to view it as a self-modifiable condition rather than a long-term disease.
Results also showed a pattern in self-blame among people living with obesity, with even those who are accepting of AOM use viewing it to further support their own lifestyle changes.
HCPs also shared an opposing view. They consider obesity as a long-term disease, but many expressed hesitancy in prescribing AOMs because they see them as a short-term solution. HCPs had concerns that ranged from lack of safety and efficacy data on current treatments to limited understanding of obesity management overall.
With low prescribing rates among HCPs, employers perceived a low demand for AOMs. They tended to deprioritize coverage considerations for the medication when building benefits packages.
This led to insufficient awareness of the impact of obesity and resulted in challenges with coverage and out-of-pocket costs for people who may benefit from AOM use. Many employers also expressed lack of understanding of AOMs overall and default to corporate wellness programs as solutions for obesity.
With three of the most influential groups in obesity care showing biases, misperceptions and education gaps about AOMs, it’s clear that challenges in obesity care are vast and deeply rooted.
People with Obesityii
In 2022, Lilly revealed OBSERVE study results, which looked deeper at the perceptions of people with obesity, both toward the disease itself and potential treatments, including AOMs.
The next phase of results reiterated that two-thirds of participants living with obesity don’t categorize their weight as “obese.” Only half believe obesity is a disease. But despite scientific evidence, a small number of participants in viewed obesity as the primary result of body dysfunction.
Eighty-six percent of participants agreed that obesity impacts long-term health and increases the chance of developing other health problems like physical function (82%) and emotional well-being (77%). But only 45% felt it requires treatment by a healthcare provider.
We also looked closer at how people living with obesity viewed treatment options. When participants were asked about AOMs, almost three-quarters believed that lifestyle and behavioral changes are the best options for long-term weight loss, with 64% unaware of prescription AOMs that could help manage weight.
While most people living with obesity seem to understand the seriousness of the disease, many still believe they can battle the disease single-handedly or are unaware or don’t approve of treatment options that can help.
Health Care Provider Perspectivesiii
The quantitative phase of the OBSERVE study includes findings from a survey of HCPs conducted from May-December 2022. The survey deepens our understanding of their perceptions of obesity, AOMs and barriers to AOM utilization.
While 58% of HCPs agreed obesity is a primary result of lifestyle choices, approximately two-thirds of those surveyed also said obesity requires treatment by an HCP. Additionally, nearly all HCPs shared the belief that obesity increases the chances of developing other health problems in the future (94%) and obesity has a significant impact on mental health and/or emotional well-being (93%).
HCPs agreed that AOMs help patients feel more in control of their health (71%) and they see AOMs as a way to help kick start a patient in their weight loss efforts (73%), but also had concerns about their use as well.
The majority of HCPs believed AOMs are an appropriate treatment for obesity when used in conjunction with diet and exercise (72%), but that insurance does not adequately cover their cost (71%). Many also believed sustained weight loss will still require a lifestyle change and that there is a need for more effective AOM options.
This phase of the study also includes findings from human resource professionals, benefits consultants and employer coalition representatives to examine their perceptions of AOMs and how these treatments fit into employer-provided health plans.
This group of human resource leaders was generally positive about AOMs and the promise they have for people living with obesity as part of a comprehensive lifestyle approach:
AOMs were seen as a comprehensive weight-management approach with most respondents agreeing that AOMs would be most effective as part of a larger lifestyle program (92%) and would complement obesity management benefits offered through a standard wellness program (84%).
Most respondents agreed that AOMs could help employees feel more in control of their weight (92%) and improve health-related quality of life (84%).
AOMs were also viewed as effective over the long term (80.4%) with almost two-thirds (61%) believing AOMs can be used for at least 2 years. When questioned about the barriers employers are facing to AOM coverage for their employees, 73% mentioned anticipated cost to employers and 69% affordability concerns for employees.
In order to cover AOMs, these employers agreed they would need to see more evidence supporting AOM coverage, such as demonstrated return on investment (79%), reduction in premiums or claims (78%) and clear clinical and financial benefit of AOMs from insurance providers (73%). This lack of evidence supporting AOMs for people with obesity is a result of the perception that direct tracking of obesity-related claims is difficult (75%) and that HCPs often fail to document obesity (65%), according to respondents.
Perspectives on Desired Weightv
In this portion of the OBSERVE study, people with obesity’s perception of weight and desired weight loss were evaluated to determine how patient preferences ladder up to guideline-recommended weight loss targets. This cross-sectional study was conducted from May-December 2022 using an online survey with adults eligible for AOMs based off their body mass index (BMI).
People with obesity and people with overweight with ≥1 weight-related condition shared their current weight and preferred weight-reduction percentage associated with five weight-reduction targets:
Dream (24%): The weight respondents would reach and maintain if they could weigh whatever they wanted
Goal (17%): The weight respondents realistically expect to achieve and maintain when trying to lose weight
Happy (15%): The weight that is not as ideal as a “dream weight,” but respondents would be happy to achieve and maintain
Acceptable (10%): The weight respondents might not be happy with but could accept if they achieved and maintained it
Disappointing (5%): The weight that respondents would not view as successful in any way even if they achieve and maintain weight loss
Beyond demonstrating that people living with obesity and overweight desire their “dream” or “goal” weight reductions, the survey also found that gender, BMI category and race and ethnicity played a role in preferred weight reductions. For instance, younger and middle-aged adults, women and lower-income individuals desired more weight reductions. Since findings also showed that people with obesity or overweight facing weight-self stigma* were more likely to desire a greater preferred weight reduction, health care providers and people living with obesity may benefit from a shared decision-making that considers patients’ preferences for weight reduction outcomes.
Looking Ahead to a Brighter Future
These OBSERVE findings continue to underscore that the misperceptions and stigmas around obesity are having a domino effect across several key players. It is evident we need more education and awareness to understand obesity is a disease that sometimes requires not only lifestyle changes, like diet and exercise, but medical interventions as well. We hope the study insights can help guide decisions, improve education and shift perspectives to implement effective evidence-based approaches to obesity care.
* Internalized weight stigma was determined using the Weight Self-Stigma Questionnaire global score, which measures weight self-stigma using a 5‐point Likert‐type rating that ranges from ‘completely disagree’ to ‘completely agree’.
i Kaplan LM, Kumar RB, Kahan S, et al. Perspectives of anti-obesity medication use among persons with obesity and health care providers. Poster presented at ObesityWeek® 2021; November 1-5, 2021.
ii Kaplan LM, Kumar RB, Ahmad NN, et al. Experience and perception of anti-obesity medications among persons with obesity or overweight. Poster presented at ObesityWeek® 2022; November 1-4, 2022; San Diego, CA.
iii Kahan S. Kumar RB, Ahmad NN, et al. Healthcare providers’ perceptions of anti-obesity medications: results from the OBSERVE study. Poster presented at: AACE Annual Meeting 2023; May 4-6, 2023; Seattle, WA.
iv Gudzune KA, Kumar RB, et al. Barriers to employer uptake of anti-obesity medication coverage: Results from the OBSERVE study. Poster presented at ObesityWeek® 2023; October 14-17, 2023.
v Kan H, Gudzune KA, et al. Variation in weight loss goals of adults from U.S. meeting BMI criteria for anti-obesity pharmacotherapy. Poster presented at ObesityWeek® 2023; October 14-17, 2023.