The Dizzy Pace of Change in Prescribing for Obesity Care

VertigoA new paper in JAMA Network Open documents just how dizzy the pace of change in prescribing for obesity care has been in the last seven years. Prescriptions for obesity medicines have doubled. Phentermine prescribing has grown – it’s generic, cheap, and effective. Even now, it accounts for almost half of obesity medicine prescriptions. But newer drugs like liraglutide, semaglutide, and tirzepatide are getting all the attention and catching up.

What’s more, the pattern of who prescribes these medicines is changing dramatically.

Advanced Practice Practitioners

We were accustomed to the presumption that prescriptions for obesity care came largely from the emerging specialty of obesity medicine physicians. And it’s true that the specialty has grown dramatically since it emerged under the banner of the American Board of Obesity Medicine in 2011. It is one of the fastest growing medical specialties.

But in their new paper, Philipp Berning and colleagues make it clear that the biggest change in prescribing for obesity care has come from advanced practice providers. These are nurse practitioners and physician associates who have jumped right in to fill the gap between the tremendous medical need for obesity care and relatively slow response of physicians to meet the need. In 2017, primary care physicians and internists were prescribing 58% of the obesity medicines dispensed in America. By 2024, that number dropped to 48%.

Meanwhile advanced practice providers have gone from doing 25% of the prescribing to 41%. At a time when prescriptions have doubled, that is a whole lot of growth. As we have said here many times, delivering care at scale is the biggest challenge we face in obesity medicine.

Clearly, advanced practice providers are very important for meeting that challenge. And the dizzy pace of change in prescribing for obesity care will continue.

Click here for the study in JAMA Network Open, here, here, and here for further perspective.

Vertigo, India ink brush wash and colored pencil on paper by Léon Spilliaert / Wikimedia Commons

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January 30, 2025

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