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. 2017 Apr;32(Suppl 1):70-73.
doi: 10.1007/s11606-016-3949-y.

Pharmacotherapy for Weight Management in the VHA

Todd P Semla  1   2 , Chris Ruser  3   4 , Chester B Good  5   6   7 , Susan Z Yanovski  8 , Donna Ames  9   10 , Laurel A Copeland  11 , Charles Billington  12 , U Inge Ferguson  13 , Louis J Aronne  14 , Thomas A Wadden  15 , W Timothy Garvey  16   17 , Caroline M Apovian  18 , David Atkins  19
Affiliations

Pharmacotherapy for Weight Management in the VHA

Todd P Semla et al. J Gen Intern Med. 2017 Apr.

Abstract

Weight management medications (WMM) are underutilized as an adjunct to behavioral and lifestyle interventions. In fiscal years 2014-2015, a total of approximately 2500 veterans-a mere 2% of veterans receiving care from the Veterans Health Administration (VHA)-eligible for a WMM received a prescription for one. A State of the Art Conference on Weight Management workgroup, focused on pharmacotherapy, developed evidence-based recommendations and strategies to foster the appropriate use of WMM in the VHA. The workgroup identified patient, prescriber, and health system barriers to and facilitators for prescribing WMM. Barriers included patient and provider concerns about medication safety and efficacy, limited involvement of primary care, restrictive medication criteria for use (CFU), and skepticism among providers regarding the safety and efficacy of WMM and the perception of obesity as a disease. Potential facilitators for removing barriers included patient and provider education about WMM and the health benefits of weight loss, increased engagement of primary care providers in weight management, relaxation of the CFU, and creation of a system to help patients navigate through weight management treatment options. Several research questions were framed with regard to WMM in general, and specifically to the care of obese veterans. While some of the workgroup's conclusions reflect issues specific to the VHA, many are likely to be applicable to other health organizations.

Keywords: obesity; pharmaceutical care; veterans.

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Conflict of interest statement

Todd P. Semla, MS, PharmD – spouse is an employee of Abbvie and formerly of Abbott Labs, and owns stock in both companies. Chris Ruser, MD – none. Chester B. Good, MD, MPH – none. Susan Z. Yanovski, MD – spouse receives research project support from Zafgen and Rhythm Pharmaceuticals. Donna Ames, MD – none. Laurel A Copeland, PhD – Mallinckrodt (grant support). Charles Billington, MD – Novo Nordisk. U. Inge Ferguson, DO – none. Louis Aronne, MD – Stock ownership: BMIQ, Zafgen Inc., ERx, MYOS Corporation; Consultancies: Johnson & Johnson, Ethicon Endo-Surgery Inc., VIVUS, Inc., Novo Nordisk A/S, GI Dynamics; Grants received: Eisai, Inc., Astra Zeneca. Thomas Wadden, PhD – serves on advisory boards for Weight Watchers, Nutrisystem, and Novo Nordisk. Tim Garvey, MD – Consultancies: Novo Nordisk, Janssen, Alexion, VIVUS, Eisai, Takeda, AstraZeneca, Merck; Research sponsored by institution (UAB) with Dr. Garvey as site PI: Merck, AstraZeneca, Weight Watchers, Eisai, Pfizer, Novo Nordisk, Lexicon, Elcelyx; Stock ownership (all publically traded): Eli Lilly, Pfizer, Novartis, Merck, Isis, Bristol-Myers-Squibb. Caroline Apovian, MD – Consulting: Merck, Johnson & Johnson, Arena Nutrisystem, Zafgen, Sanofi-Aventis, Orexigen, EnteroMedics, Scientific Intake, Gelesis, Takeda Pharmaceuticals U.S.A., Novo Nordisk; Stock ownership: Science Smart LLC; Research funding: Lilly, Aspire Bariatrics, GI Dynamics, Pfizer, Sanofi-Aventis, Orexigen, MetaProteomics, the Dr. Robert C. and Veronica Atkins Foundation, and MYOS Corporation. David Atkins, MD, MPH – none.

References

    1. Department of Veterans Affairs and Department of Defense. VA/DoD Clinical Practice Guideline for Screening and Management of Overweight and Obesity, version 2.0, 2014. http://www.healthquality.va.gov/guidelines/CD/obesity/CPGManagementOfOve... Accessed July 17, 2016.
    1. Kahwati L, Trang XL, Jones KR, Kinsinger LS. RE-AIM evaluation of the Veterans Health Administration’s MOVE! Weight Management Program. Transl Behav Med. 2011;1:551–60. doi: 10.1007/s13142-011-0077-4. - DOI - PMC - PubMed
    1. U.S. Department of Veterans Affairs MOVE! Weight Management Program. Available at: http://www.move.va.gov/. Accessed July 22, 2016.
    1. Data from the Pharmacy Benefits Management Services (PBM) prescription database (Hines, IL). July 21, 2016.
    1. Bessesen DH, McCormick E, Saxon DR, et al. Patterns of prescribing of weight loss medications in a large cohort of adults. LB-OR02-05 Presented at the ENDO2016, The Endocrine Society Annual Meeting, Boston, MA, April 3, 2016. Available at: https://endo.confex.com/endo/2016endo/webprogram/Paper28282.html Accessed July 21, 2016.

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