Can’t, Won’t, Don’t: Why People Stop Taking Obesity Medicines

In a world that systematically denies people access to obesity medicines, the rush of reports that people frequently stop taking them makes us wonder. How does this qualify as news? Why do reporters repeatedly paint a misleading picture of non-compliant patients?

Yet, health reporters keep offering up this narrative. The latest prompt for this is a report from Blue Health Intelligence for the Blue Cross Blue Shield Association.

Real World Prescribing and Persistence

This is a truly fascinating report. It provides great detail on patterns of prescribing and use of liraglutide and semaglutide for obesity, omitting tirzepatide because it was too new to the market. The aim of the research was “to explore if patients prescribed GLP-1s for weight loss are dropping out of treatment too quickly to attain the health benefits of these drugs.”

No surprise, they found what they were seeking. About 30% of patients stop taking these medicines within four weeks. The report finds that the patients most likely to drop out are younger, suffer from health inequities, get care from providers lacking expertise in obesity medicine, or do not see their providers frequently. All of this offers useful insights.

But it comes with a bias, focusing solely on the “failure” of patients to stick with this therapy:

“When looking at patients using GLP-1 drugs for weight management, our findings show that most individuals did not stay on their prescribed treatment for a minimum of 12 weeks, suggesting that they were unlikely to achieve clinically meaningful weight loss.”

What’s missing? Any mention of the hurdles that health insurance and shortages create for patients who wish to keep taking these medications. Should we be surprised that a health insurance report would omit any mention that they might be part of the problem? Nope.

A Very Real Problem

A report from NPR tells us that unwanted interruptions in therapy are a huge problem for people who really want to continue with these medications. Pediatrician Natalie Muth told reporter Yuki Noguchi the interruptions to therapy have been very distressing to her patients. “They felt it, they missed it, they were really distressed about it.”

Prior authorizations are a problem for getting access to care across the board in medicine. It can be absurdly profitable, but highly problematic for both patients and providers. In obesity medicine, it imposes an outrageous overhead on medical practices and becomes a roadblock to providing care for the health of patients. Ridiculous requirements – like refusing to pay if a patient requires a low dose – pop up frequently.

So is it mysterious that patients frequently stop obesity medicines before they see the benefits? Not at all. In fact, high costs, insurance problems, and drug shortages make it likely. But, as with most things in obesity, the prevailing bias favors blaming patients.

Click here for the report from Blue Health Intelligence, here for the report from NPR, and here for more on prior authorizations. For a sample of hand-wringing reports on how patients just won’t keep taking their medicine, click here and here.

Stop and Warning Signs in Malaysia, photograph by Uwe Aranas, licensed under CC BY-SA 3.0

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May 30, 2024