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. 2022 Jul:11:100249.
doi: 10.1016/j.lana.2022.100249. Epub 2022 Apr 2.

Socioeconomic status and use of obesogenic and anti-obesity medications in the United States: A population-based study

Beini Lyu  1 , Alex R Chang  2 , Lesley A Inker  3 , Elizabeth Selvin  1   4 , Morgan E Grams  1   4   5   6 , Jung-Im Shin  1   5   6
Affiliations

Socioeconomic status and use of obesogenic and anti-obesity medications in the United States: A population-based study

Beini Lyu et al. Lancet Reg Health Am. 2022 Jul.

Abstract

Background: The Endocrine Society Clinical Practice Guidelines recommend the avoidance of medications that may cause weight gain (i.e., obesogenic medications) in individuals with overweight or obesity. Obesity disproportionately affects people with lower socioeconomic status (SES); however, it is unknown whether the use of obesogenic medications differs by SES.

Methods: We included adults with overweight or obesity and used prescription medications from 2009-2018 of the US National Health and Nutrition Examination Survey. We examined the associations between a composite measure of SES and use of obesogenic medications and anti-obesity medications. The composite SES included <high school education (1 point), household income below federal poverty level (1 point), no insurance (2 points), and public health insurance only (1 point). We defined 3 composite SES groups (0 [high], 1 [intermediate], and ≥2 points [low]).

Findings: Among 10,673 US adults with overweight or obesity, 20.0% had low SES. Use of obesogenic medications was common (37.7%). Low (vs. high) SES was associated with greater obesogenic medication use, independent of demographic characteristics, prescription medication burden, and comorbidities (OR 1.3 [1.2-1.5]). Among 12,133 eligible participants, utilization of anti-obesity medications was very low overall (0.5%) and within all SES groups (low 0.27%, intermediate 0.71, and high 0.65%).

Interpretation: Our findings highlight common and modifiable risk factors for obesity. Clinicians should screen patient medications for those that may cause weight gain and increase adoption of anti-obesity medications, especially among adults living in low SES.

Funding: The National Institute of Diabetes and Digestive and Kidney Disease (R01DK115534, K24HL155861, and K01DK121825).

Keywords: Disparities; Obesity; Obesogenic medications; Pharmacoequity; Socioeconomic status.

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Conflict of interest statement

Dr. Alex Chang has served as a scientific advisor to Reata, Amgen, and Novartis, and he receives research funding from Novo Nordisk. Dr. Jung-Im Shin received funding from Merck, outside of the submitted work. The other authors declared no competing financial interests in relation to the work.

Figures

Fig 1
Figure 1
Mean (95% confidence interval) body mass index (BMI) by socioeconomic status, NHANES 2009-2018. Significant differences in BMI across composite SES and individual SES groups (p < 0.05 for all).
Fig 2
Figure 2
Adjusted* predicted probability of use of obesogenic medications among US adults who had overweight or obesity and took at least one prescription medication by (a) composite SES, (b) education, (c) household income, and (d) type of health insurance, NHANES 2009-2018. *The model adjusted for age, sex, race/ethnicity, number of prescription medications, diabetes, depression, hypertension, cardiovascular disease, and arthritis.
Fig 3
Figure 3
Prevalence (95% confidence interval) of sulfonylurea use among US adults with diabetes, overweight/obesity, and on non-insulin antidiabetic medications by (a) composite SES, (b) education, (c) household income, and (d) type of health insurance, NHANES 2009-2018. Significant difference in prevalence of sulfonylurea use by composite SES (p=0.03) and education (p=0.004).
Fig 4
Figure 4
Prevalence (95% confidence interval) of anti-obesity use among US adults who were eligible for treatment by (a) composite SES, (b) education, (c) household income, and (d) type of health insurance, NHANES 2009-2018.
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