OR01-2 Patient Characteristics Associated with Receipt of Prescription Weight Management Medications among Veterans in a Weight Management Program

Abstract

Objective: Overweight and obesity affect over 4 million veterans receiving health care in the Veterans Administration (VA). In VA, WMM are available to any Veteran who is engaged in behavioral weight management and meets BMI criteria. In 2010, weight management medications (WMM) were found to be underused in VA, but since then new WMM have been approved and guidelines have recommended them for long-term obesity treatment. We examined the frequency of WMM use and patient characteristics associated with WMM use and with the selection of orlistat versus other WMM for veterans with overweight or obesity enrolled in the VA MOVE! behavioral weight management program. Methods: Retrospective cohort study of VA patients participating in MOVE! between October 2014 – October 2016 with body mass index (BMI)≥30kg/m2 or BMI>27kg/m2 with obesity-related comorbidities. Data from the electronic health record were accessed. Logistic regression models estimated predictors of filling a prescription for any WMM within VA and for orlistat versus other WMM. Results: Of the 153,892 eligible veterans enrolled in MOVE!, 1,888 (1.2%) received a WMM. The most common prescriptions were for orlistat (61.0%), bupropion/naltrexone (13.8%), and phentermine/topiramate (11.7%). The percent of patients receiving WMMs ranged from 0.5% among patients with overweight to 2.9% among patients with alcohol abuse. Factors associated with WMM were female sex (adjusted odds ratio (aOR) = 1.8, 95% CI: 1.6 – 2.0), higher BMI (class I obesity aOR=1.6, 95%CI: 1.3 – 2.0, class II obesity aOR=2.9, 95% CI: 2.3 – 3.6, class III obesity aOR=4.5, 95%CI: 3.6 – 5.6 compared to overweight), alcohol abuse (aOR=2.3, 95% CI: 1.8 – 2.9), substance abuse (aOR=1.6, 95% CI: 1.4 – 1.9), diabetes (aOR=1.2, 95% CI: 1.1-1.3), obstructive sleep apnea (aOR=1.3, 95% CI: 1.2 – 1.4), depression (aOR=1.2, 95% CI: 1.1 – 1.3), low back pain (aOR=1.2, 95% CI: 1.1 – 1.3). Factors associated with lower odds of WMM receipt included age over 65 years (aOR=0.7, 95% CI: 0.6 – 0.8) and required copayments (aOR=0.8, 95% CI: 0.7 – 0.8). Factors associated with receiving orlistat vs. other WMMs were increasing age (age ≥ 65 aOR=2.6, 95%CI: 1.6 – 4.1), Black/non-Hispanic race (aOR=1.5, 95% CI: 1.2 – 1.9), female sex (aOR=1.8, 95% CI: 1.4 – 2.3), hypertension (aOR=1.4, 95% CI: 1.1-1.7) and low back pain (aOR=1.6, 95% CI: 1.3-1.9). Factors associated with lower aOR for orlistat vs. other WMM were diabetes (aOR=0.7, 95% CI: 0.5-0.8), alcohol abuse (aOR=0.5, 95% CI: 0.3-0.9), and substance abuse (aOR=0.4, 95%CI: 0.3-0.6). Conclusion: There is a substantial opportunity to increase the use of WMM for weight management in eligible veterans engaged in MOVE!. Patient characteristics affect whether veterans receive WMM, and which WMM is used. Additional research is needed to understand provider and patient decision-making regarding WMM and address barriers to incorporating WMM into obesity treatment.