Pharmacological interventions demonstrate fewer disparities in obesity treatment than behavioral and surgical treatment, a new literature review has found.
The peer-reviewed review was recently published in European Society of Medicine. It analyzed 44 studies examining obesity treatment options that reported race data from 2000 to 2022, and was conducted by a group of academic researchers and supported by Enara Health, a company that helps stakeholders stand up obesity management programs.
While most behavioral and surgical treatment studies found disparities in weight loss and clinical outcomes, pharmacological studies found minimal to no evidence of disparities and favorable outcomes for minorities. All treatment pathways, however, showed disparities in referral rates, access and engagement or retention.
The COVID-19 pandemic highlighted notable differences in morbidity and mortality among people struggling with obesity, the review said. People with obesity have three times the risk of hospitalization from the virus and a significant association with worse outcomes. Minorities also have a higher prevalence of obesity than their white counterparts.
When assessing lifestyle interventions primarily focused on physical activity and diet, most studies analyzed found that Black individuals and especially Black women lost significantly less weight than others. A majority of studies also found evidence of decreased retention or engagement among minorities. This might be due to socio-economic barriers, the review said.
“These findings highlight the need for culturally tailored and accessible lifestyle interventions that effectively cater to the needs of minority populations,” the review said. It also called for more research exploring how Hispanic and Asian communities respond to behavioral treatments compared to other groups.
When it comes to surgical treatment of obesity, disparities ran the gamut from referral rates and access to perioperative care to operative outcomes and postoperative outcomes. These disparities may be driven by things like social determinants of health and systemic bias, the review said. It called for more research to better understand and address disparities.
However, when it comes to pharmacological interventions, most studies analyzed did not find statistically significant differences between racial groups. This could be due to the standardized nature of pharmacological treatment and controlled trials, which are less influenced by socio-cultural variables.
Most current studies on pharmacological interventions are in highly controlled settings, according to the review’s corresponding author Ramy Bailony, M.D., co-founder and CEO of Enara Health. Such studies — often controlled trials — also tend to be based on small datasets, he added. In the real world, minorities have the greatest need for medications but the lowest coverage of them. Thus, the finding that there are fewer disparities in pharmacological interventions is subject to change, Bailony told Fierce Healthcare.
While medications for obesity hold promise, uneven access to these medications would exacerbate disparities. Such access hangs on equitable insurance coverage and affordable pricing.
“Both surgery and medication have the chance to biologically help people lose weight,” Bailony said. “But if the access to the treatment is limited…then I think we’re left in a scenario where obviously health equity could become worse.”
Education and programming around medications will be key to addressing disparities, Bailony and his co-authors argue. Effective obesity management typically combines medication with lifestyle alterations and in some cases surgical treatment. Simply covering obesity medications without investing in these areas would undermine efforts to address obesity disparities, they wrote.
Payers and governments should ensure equal coverage and investment in all services.
“If we really want to use these medications the right way we’re going to have to…incentivize providers and provider groups to create community-tailored programming and care loops,” Bailony said. “If good access to the medication is not there and good care is not there, around these medications, do we undo the potential of these meds to equal the playing field?”
The Centers for Medicaid & Medicare Services reimburses physicians about $25 for 15 minutes of obesity counseling. “That’s really not going to be enough when you’re dealing with complex social and economic conditions,” Bailony said. “We need a broader innovation cycle that is beyond the medication to really get this right.”