Sharma Arya M, Birney Susie, Crotty Michael, Finer Nick, Segal-Lieberman Gabriella, Vázquez-Velázquez Verónica, Vrijens Bernard
Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
Irish Coalition for People Living with Obesity, Dublin, Ireland.
Obes Rev. 2025 May;26(5):e13885. doi: 10.1111/obr.13885. Epub 2025 Jan 20.
The increasing prevalence of obesity, complex nature of this chronic disease, and risks of developing obesity-related comorbidities outline the need for sustainable and effective management for people living with obesity. In addition to behavioral interventions, obesity medications (OMs) are increasingly considered an integral part of management of people living with obesity. OM adherence is essential to achieve the health benefits of these medications. Adherence to medications, defined as the process by which patients take their medications as prescribed, is determined by a range of factors and can be broken down into phases: initiation, implementation, and persistence (the persistence phase includes discontinuation/stopping treatment). Obesity-specific challenges exist to optimize OM adherence, which may explain varying OM adherence compared with medication for other chronic diseases (diabetes, hypertension, dyslipidemia, and osteoporosis). However, lessons can be learned from other chronic diseases to improve OM adherence, for example from type 2 diabetes and hypertension. This review aims to provide practical guidance for identifying OM- and obesity-specific determinants of adherence and discusses adherence determinants per adherence phase and obesity management phase (weight gain, weight loss, and weight stabilization/regain). This practical guidance will assist with developing obesity-specific interventions to improve OM adherence. PRACTITIONER POINTS: OMs are increasingly considered as an integral part of obesity management; however, like with all chronic disease medications, low adherence to these medications is often observed, impacting their therapeutic effect. Adherence to obesity medication can be affected at any phase of obesity management (weight gain, weight loss, and weight stabilization/regain) so considering the disease phase can help identify potential reasons for low adherence. Future initiatives to improve adherence to obesity medication should be a key focus of discussions at each opportunity with healthcare professionals, including thorough evaluation and targeted education, all in a supportive and stigma-free manner.
肥胖症的患病率不断上升，这种慢性病性质复杂，且存在发展为肥胖相关合并症的风险，这凸显了对肥胖症患者进行可持续有效管理的必要性。除行为干预外，肥胖症药物（OMs）越来越被视为肥胖症患者管理的一个组成部分。OMs的依从性对于实现这些药物的健康益处至关重要。药物依从性定义为患者按规定服药的过程，它由一系列因素决定，并可细分为几个阶段：起始、实施和持续（持续阶段包括停药/停止治疗）。在优化OMs依从性方面存在肥胖症特有的挑战，这可能解释了与其他慢性病（糖尿病、高血压、血脂异常和骨质疏松症）药物相比，OMs依从性存在差异的原因。然而，可以从其他慢性病中吸取经验教训来提高OMs依从性，例如从2型糖尿病和高血压中吸取经验。本综述旨在为确定OMs和肥胖症特有的依从性决定因素提供实用指导，并讨论每个依从阶段和肥胖症管理阶段（体重增加、体重减轻和体重稳定/恢复）的依从性决定因素。这种实用指导将有助于制定肥胖症特有的干预措施以提高OMs依从性。从业者要点：OMs越来越被视为肥胖症管理的一个组成部分；然而，与所有慢性病药物一样，这些药物的依从性往往较低，影响其治疗效果。在肥胖症管理的任何阶段（体重增加、体重减轻和体重稳定/恢复），肥胖症药物的依从性都可能受到影响，因此考虑疾病阶段有助于确定依从性低的潜在原因。未来提高肥胖症药物依从性的举措应成为每次与医疗保健专业人员讨论的重点，包括进行全面评估和针对性教育，所有这些都应以支持性和无污名的方式进行。
