Obesity is the most prevalent chronic disease in America, so you might think that prescriptions for obesity medicines are relatively common – but only if you are unfamiliar with prevailing attitudes about these medicines. Because in fact, even in a large health system known for excellent care in cardiometabolic health, these prescriptions are rather rare. In a sample of more than 50,000 patients with obesity and seeking care for it in the Cleveland Clinic system, Hamlet Gasoyan and colleagues found that 92% of these people never got a single prescription for an obesity medicine. Even fewer – only four percent of the sample – ever filled them.
In Diabetes, Obesity, and Metabolism, Gasoyan et al published their new and fascinating analysis of who does and doesn’t get prescriptions for these medicines.
Clear Disparities: Gender, Race, Ethnicity, and Insurance
In sum, being a white, non-Hispanic woman with good private insurance seems to be the ticket for getting a prescription for obesity. With a prescription in hand, the odds for filling it go down further if you are male or Hispanic. It also seems that the odds of getting a prescription filled for either liraglutide or orlistat are especially low. Medicaid and, of course, Medicare lower the odds of getting any obesity medicine prescription filled.
Medicare simply blocks coverage of any prescriptions for obesity medicines.
One important note is that these data go through 2022. Things are changing fast with prescriptions for obesity medicines and, no doubt, data from 2023 and 2024 will present a different picture.
Geographic Differences
An analysis of more recent data on prescriptions for GLP-1 medicines (Ozempic, Wegovy, Mounjaro, Zepbound) also tells us there are great differences in prescribing by geography.
Kentucky and West Virginia are the states in this analysis with the highest rates of prescribing (per 1,000 people) for these medicines. Alaska, Mississippi, and Louisiana came in third, fourth, and fifth GLP-1 prescriptions. Note that the drugs included here might be used for diabetes, obesity, or both indications. So strictly speaking, this is not an analysis of prescribing for obesity medicines.
At the bottom of the list were Rhode Island and Massachusetts. In Rhode Island, the rate of prescribing is less than one fifth of what it is in Kentucky. We note that the BRFSS estimate from CDC for obesity prevalence is 31% in Rhode Island and 38% in Kentucky.
California, where urban legend has it that West Coast celebrities are gobbling up all the Ozempic, is pretty low on this list. Maybe there’s a little hype stirred into that legend.
Bottom Line: Disparities
One thing is clear. Prescribing for these medicines (like their supply) is falling far short of the medical need and the disparities in access are great. Being white, female, and well-insured helps your odds if you need a medicine for obesity. Everyone else has a good chance of getting left out.
No doubt this is changing, we hope for the better. But it can’t change fast enough.