ECRI, the largest non-profit patient safety organisation in the US, is calling on healthcare leaders to change their approach and fully embrace FDA-approved weight-loss drugs. The ECRI's position paper, ‘Outdated Notions and Persisting Misconceptions Bar the Way to Effective Obesity Treatment’, outlines a series of myths about weight-loss medication - such as their perceived inconsequence for losing weight and long-term ineffectiveness for keeping it off - that have led to them being dramatically underused. The ECRI claims there is a large body of evidence that shows these drugs are beneficial as an adjunct to diet, exercise and counselling and should be considered for first-line treatment in many patients.
"Obesity is epidemic and we need comprehensive evidence-based solutions," explained Dr Marcus Schabacker, president and chief executive officer of ECRI. "By shining a spotlight on promising new evidence for weight-loss medications, we hope healthcare stakeholders and policymakers will adopt policies that better reflect current evidence-based conclusions on obesity."
ECRI researchers identified several reasons for the low rate of weight-loss drug use, including widespread scepticism of drugs' efficacy, unrealistic expectations of rapid weight loss and personal beliefs that individuals should lose weight through their own efforts alone.
However, the key barrier is financial. Subcutaneous, monthly injections list for around US$1,200 for one dose. Oral medications can cost up to US$250 for a one-month supply.
"Initial evidence is favourable for the effectiveness of weight-loss drugs, but insurance coverage is extremely limited, discouraging doctors from prescribing them and patients from using them," added Schabacker. "Insurers' unwillingness to cover weight-loss medication puts it out of reach, especially for people with low incomes who experience obesity disproportionately."
Weight-loss drugs are excluded from Medicare Part D plan requirements, and most Medicaid state plans and private plans qualifying for Affordable Care Act subsidies do not cover weight-loss drugs.
While ECRI identifies price as the main barrier, the researchers say many physicians have negative opinions of weight-loss medication based on out-of-date evidence or personal beliefs that people who are overweight or obese should lose weight through willpower and behaviour change alone, leading to low prescribing rates for weight-loss drugs.
"The United States has struggled to follow an evidence-based approach to reduce obesity," said Dr Dheerendra Kommala, chief medical officer of ECRI. "The case of weight-loss drugs illustrates the need for continuous reevaluation in evidence-based medicine to prevent outdated perceptions from taking root, address evidence gaps, and evaluate emerging interventions."
ECRI urges stakeholders to follow the FDA's evidence-based decisions in approving the use of weight-loss medicines, which can improve population health and decrease downstream costs. According to the Centers for Disease Control and Prevention, over 70% of Americans are considered over-weight or obese, and the annual cost of obesity on the US healthcare system is estimated at US$173 billion.
"Millions of people in America resolve to live healthier lives in 2023, possibly including weight loss among their goals," concluded Schabacker. "Physicians must set aside the misinformation about weight-loss drugs, and personal biases about whether and how people can recover from obesity. Every person who loses excess weight improves their health, decreases the likelihood of future medical issues, and cuts healthcare costs. We need to use every tool in our arsenal to help them."
ECRI notes that stakeholder coordination and communication, including with manufacturers, is critical to maintain a sufficient supply of drugs able to meet current and future demand, especially for those who rely on the medications for diabetes management.
ECRI received no funding from manufacturers of weight-loss drugs in preparing this independent research assessment.
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