Haggerty Treah, Dekeseredy Patricia, Bailey Joanna, Cowher Abigail, Baus Adam, Davisson Laura
Department of Family Medicine, Director of Pediatric Medical Weight Management, West Virginia University, Morgantown, WV, 26506, USA.
Department of Neurosurgery, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, 26506, USA.
Obes Pillars. 2024 Jul 22;11:100120. doi: 10.1016/j.obpill.2024.100120. eCollection 2024 Sep.
Obesity rates continue to rise in the United States. Treatment includes modification of diet, exercise, behavioral modification and medical consideration including anti-obesity medications. However, multiple highly effective anti-obesity medications are expensive and with that we see insurers opting out of coverage of these medications. This has led to patients having to abruptly stop treatment with these medications. The purpose of this study is to explore the impact of non-medical discontinuance of obesity medication among patients in medical weight management programs.
This is a qualitative descriptive study. Semistructured interviews were completed with participants in an academic medical weight management clinic. Interviews were recorded and transcribed. Themes were identified by members of the study team through qualitative content analysis. Participants were on or about to start anti-obesity medications and were from a single insurance company which cut coverage to all anti-obesity medications.
Twenty-two insured patients from across the state either currently taking or intending to take anti-obesity medications, participated. All participants were female. Few participants said they could afford the cost of the medication. Four main themes emerged: 1) Feelings of hope replaced by hopelessness upon loss of medication coverage, 2) Anger regarding the perceived injustice of anti-obesity medication coverage termination, 3) Perceptions of past and present stigma within the healthcare system and insurance company, 4) Generational influences on obesity treatment.
Patients perceive the discontinuation of anti-obesity medication coverage as stigmatizing and unjust, leading to feelings of hopelessness and fear. With more insurance companies denying coverage for these costly medications more information is needed to identify best ways to address the loss of coverage with patients. Clinical management of these patients should incorporate evidence-based obesity treatments while navigating insurance constraints.
美国的肥胖率持续上升。治疗方法包括饮食调整、运动、行为改变以及药物治疗，其中药物治疗包括使用抗肥胖药物。然而，多种高效的抗肥胖药物价格昂贵，因此我们看到保险公司拒绝承保这些药物。这导致患者不得不突然停止使用这些药物进行治疗。本研究的目的是探讨在医学体重管理项目中，患者非因医疗原因停用肥胖药物所产生的影响。
这是一项定性描述性研究。对一家学术性医学体重管理诊所的参与者进行了半结构化访谈。访谈进行了录音和转录。研究团队成员通过定性内容分析确定了主题。参与者正在服用或即将开始服用抗肥胖药物，且均来自同一家削减了所有抗肥胖药物承保范围的保险公司。
来自全州的22名参保患者参与了研究，他们目前正在服用或打算服用抗肥胖药物。所有参与者均为女性。很少有参与者表示他们能够承担药物费用。出现了四个主要主题：1）药物承保范围丧失后，希望感被绝望感所取代；2）对终止抗肥胖药物承保的不公正感感到愤怒；3）对医疗系统和保险公司过去及当前耻辱感的认知；4）代际因素对肥胖治疗的影响。
患者认为抗肥胖药物承保范围的终止具有耻辱性且不公正，这导致了绝望和恐惧的情绪。随着越来越多的保险公司拒绝承保这些昂贵的药物，需要更多信息来确定应对患者承保范围丧失的最佳方法。在应对保险限制的同时，对这些患者的临床管理应纳入基于证据的肥胖治疗方法。
