Asians, non-Hispanic Blacks and Hispanics were significantly less likely than whites to use obesity-management medications to lower their weight compared with whites, new research suggests. The differences could not be fully explained by income or education level, health insurance coverage or clinical need.
The study, published in the peer-reviewed Journal of Racial and Ethnic Health Disparities, is one of the few to compare the use of obesity-management medications across racial and ethnic groups, and the first to consider how socioeconomic status might contribute to these disparities, said Dr. Kimberly Narain , primary care physician, obesity medicine specialist and researcher in the division of general internal medicine and health services research at the David Geffen School of Medicine at UCLA , who co-authored the paper with Dr. Christopher Scannell, primary care physician and researcher at USC.
The findings suggest that more research is needed to explain these differences, she said.
"People who are Asian typically develop diseases related to obesity such as Type 2 diabetes at lower levels of obesity than people who are non-Hispanic white," Narain said. "Black and Hispanic individuals are more likely to experience obesity, develop diseases related to obesity and suffer complications from obesity-related diseases than people who are non-Hispanic white."
"Our findings suggest that people with obesity from racial and ethnic minority backgrounds may face barriers to obtaining medications to treat obesity," she said.
The researchers used data from the Medical Expenditure Panel Survey for the years 2011-2016, 2018 and 2020, controlling them for demographics, socioeconomic status, obesity class, diabetes status, number of chronic conditions, insurance status and geographic region. The study sample contained 91,100 adults who were eligible for obesity management drugs. Of those, 68% were classified as obese and 32% were classified as overweight with at least one weight-related condition. Broken down by race and ethnicity, about 3% were Asian, 14% were Black, just under 16% were Hispanic, and about 68% were white.
The researchers focused on all FDA-approved medications to treat obesity available during the time period of the study. They also conducted an analysis that considered potential off-label use of GLP-1 receptor agonists FDA-approved for the treatment of diabetes, which also may lead to weight loss.
They found that Asians were 64% less likely, Blacks 49% less likely, and Hispanics 30% less likely than whites to use obesity-management medications, after taking level of obesity, number of clinical conditions, diabetes status, insurance type, demographics, socioeconomic status and census region into account.
While income, education, health insurance type and clinical need did not fully account for these disparities, the researchers suggest that lower education and either a lack of insurance, reliance on public health insurance or inadequate health insurance coverage may at least partially explain the disparities among Blacks and Hispanics, while lower Body Mass Index (BMI) may explain some of it among Asians. In addition, there may be cultural differences in the acceptance of larger body types and the acceptability of medications to treat obesity that may underlie some of these differences. Lastly, differences in how medical providers communicate with individuals across racial and ethnicity may be playing a role in these differences.
There are limitations to the findings. The researchers could not determine causality about relationships between race, ethnicity and use; they had to rely on BMI, which is a flawed measure among some groups, for eligibility for the medications; and the medications they considered did not include newer FDA-approved obesity medications.
But a full understanding of the factors that drive, or prevent, use of these medications among racially and ethnically diverse populations is crucial to ensuring that everyone has equal access to these medications, Narain said.
"It will be important to gather information from racially and ethnically diverse individuals regarding their perspectives on using medications to treat obesity," she said. "We need more investigation into the role of other potential drivers of these differences that we didn't consider in this study, such as health insurance benefit design."
Narain is supported by a NIH/NIA K08 award (K08AG068372-01), a pilot grant from the NIH/NIDDK UCLA LIFT-UP (Leveraging Institutional support For Talented, Underrepresented Physicians and/or Scientists) (1U24DK132746-01) and the Iris Cantor-UCLA Women's Health Center Leichtman-Levine TEM Scholars Fund.
Article: [Journal of Racial and Ethnic Health Disparities, 10.1007/s40615-024-02248-x]
