Skip to main content
Top
Published in: BMC Public Health 1/2014

Open Access 01-12-2014 | Research article

The relationship between BMI and the prescription of anti-obesity medication according to social factors: a population cross sectional study

Authors: Lynsey Patterson, Frank Kee, Carmel Hughes, Dermot O’Reilly

Published in: BMC Public Health | Issue 1/2014

Login to get access

Abstract

Background

Obesity is a global public health problem. There are a range of treatments available with varying short and long term success rates. One option is the use of anti-obesity medication the prescription of which has increased dramatically in recent years. Despite this, little is known about the individual and GP practice factors that influence the prescription of anti-obesity medication.

Methods

Multi-level logistic regression analysis was used to investigate factors associated with the prescription of anti-obesity medication in Northern Ireland using a population primary care prescribing database (~1.5 million people aged 16+ years) during 2009/10.

Results

While 25.0% of people are obese, only 1.3% (2.1% of females, 0.6% of males) received anti-obesity medication. The relationship between medication rates and age differed by gender (P < 0.001) with prescriptions higher in younger females and older males. Prescribing of anti-obesity medication reflected obesity prevalence across urban/rural areas and deprivation. There was an unexplained two-fold difference, between the 25th and 75th percentile, in the GP practice prescription of anti-obesity medication.

Conclusions

There is evidence of relative under-prescribing in males compared to females despite a similar prevalence of obesity. While the prevalence (and presumably the health consequences) of obesity worsens with age, younger females are more likely to be prescribed anti-obesity medication. This suggests an element of patient demand. Educational material to improve the understanding of the role of anti-obesity medication, for patients and practitioners, is recommended. But further study is needed to understand the factors responsible for the variation in prescribing between GP practices.
Literature
1.
go back to reference Wang YC, McPherson K, Marsh T, Gortmaker SL, Brown M: Health and economic burden of the projected obesity trends in the USA and the UK. Lancet. 2011, 378: 815-825. 10.1016/S0140-6736(11)60814-3.CrossRefPubMed Wang YC, McPherson K, Marsh T, Gortmaker SL, Brown M: Health and economic burden of the projected obesity trends in the USA and the UK. Lancet. 2011, 378: 815-825. 10.1016/S0140-6736(11)60814-3.CrossRefPubMed
2.
go back to reference Wadden TA, Volger S, Sarwer DB, Vetter ML, Tsai AG, Berkowitz RI, Kumanyika S, Schmitz KH, Diewald LK, Barg R, Chittams J, Moore RH: A Two-year randomized trial of obesity treatment in primary care practice. N Engl J Med. 2011, 365: 1969-1979. 10.1056/NEJMoa1109220.CrossRefPubMedPubMedCentral Wadden TA, Volger S, Sarwer DB, Vetter ML, Tsai AG, Berkowitz RI, Kumanyika S, Schmitz KH, Diewald LK, Barg R, Chittams J, Moore RH: A Two-year randomized trial of obesity treatment in primary care practice. N Engl J Med. 2011, 365: 1969-1979. 10.1056/NEJMoa1109220.CrossRefPubMedPubMedCentral
3.
go back to reference Burns EM, Naseem H, Bottle A, Lazzarino AI, Aylin P, Darzi A, Moorthy K, Faiz O: Introduction of laparoscopic bariatric surgery in England: observational population cohort study. BMJ. 2010, 341: c4296-10.1136/bmj.c4296.CrossRefPubMed Burns EM, Naseem H, Bottle A, Lazzarino AI, Aylin P, Darzi A, Moorthy K, Faiz O: Introduction of laparoscopic bariatric surgery in England: observational population cohort study. BMJ. 2010, 341: c4296-10.1136/bmj.c4296.CrossRefPubMed
4.
go back to reference McGauran A: More obesity surgery in England would save money, economic analysis shows. BMJ. 2010, 341: c4915-10.1136/bmj.c4915.CrossRefPubMed McGauran A: More obesity surgery in England would save money, economic analysis shows. BMJ. 2010, 341: c4915-10.1136/bmj.c4915.CrossRefPubMed
6.
go back to reference Moreira FA, Crippa JAS: The psychiatric side-effects of rimonabant. Rev Bras Psiquiatr. 2009, 31: 145-153. 10.1590/S1516-44462009000200012.CrossRefPubMed Moreira FA, Crippa JAS: The psychiatric side-effects of rimonabant. Rev Bras Psiquiatr. 2009, 31: 145-153. 10.1590/S1516-44462009000200012.CrossRefPubMed
7.
go back to reference Rucker D, Padwal R, Li SK, Curioni C, Lau DCW: Long term pharmacotherapy for obesity and overweight: updated meta-analysis. BMJ. 2007, 335: 1194-1199. 10.1136/bmj.39385.413113.25.CrossRefPubMedPubMedCentral Rucker D, Padwal R, Li SK, Curioni C, Lau DCW: Long term pharmacotherapy for obesity and overweight: updated meta-analysis. BMJ. 2007, 335: 1194-1199. 10.1136/bmj.39385.413113.25.CrossRefPubMedPubMedCentral
8.
9.
go back to reference Lacey LA, Wolf A, O’Shea D, Erny S, Ruof J: Cost-effectiveness of orlistat for the treatment of overweight and obese patients in Ireland. Int J Obes. 2005, 29: 975-982. 10.1038/sj.ijo.0802947.CrossRef Lacey LA, Wolf A, O’Shea D, Erny S, Ruof J: Cost-effectiveness of orlistat for the treatment of overweight and obese patients in Ireland. Int J Obes. 2005, 29: 975-982. 10.1038/sj.ijo.0802947.CrossRef
10.
go back to reference Ara R, Blake L, Gray L, Hernández M, Crowther M, Dunkley A, Warren F, Jackson R, Rees A, Stevenson M, Abrams K, Cooper N, Davies M, Khunti K, Sutton A: What is the clinical effectiveness and cost-effectiveness of using drugs in treating obese patients in primary care? A systematic review. Health Technol Assess. 2012, 16: ii-xiv. 1–195CrossRef Ara R, Blake L, Gray L, Hernández M, Crowther M, Dunkley A, Warren F, Jackson R, Rees A, Stevenson M, Abrams K, Cooper N, Davies M, Khunti K, Sutton A: What is the clinical effectiveness and cost-effectiveness of using drugs in treating obese patients in primary care? A systematic review. Health Technol Assess. 2012, 16: ii-xiv. 1–195CrossRef
11.
go back to reference Veerman L: Orlistat reduces weight but its cost-effectiveness remains unclear. Evid Based Nurs. 2013, 16: 56-57. 10.1136/eb-2012-100958.CrossRefPubMed Veerman L: Orlistat reduces weight but its cost-effectiveness remains unclear. Evid Based Nurs. 2013, 16: 56-57. 10.1136/eb-2012-100958.CrossRefPubMed
12.
go back to reference Padwal RS, Majumdar SR: Drug treatments for obesity: orlistat, sibutramine, and rimonabant. Lancet. 2007, 369: 71-77. 10.1016/S0140-6736(07)60033-6.CrossRefPubMed Padwal RS, Majumdar SR: Drug treatments for obesity: orlistat, sibutramine, and rimonabant. Lancet. 2007, 369: 71-77. 10.1016/S0140-6736(07)60033-6.CrossRefPubMed
13.
go back to reference Sundquist J, Johansson S-E, Sundquist K: Levelling off of prevalence of obesity in the adult population of Sweden between 2000/01 and 2004/05. BMC Public Health. 2010, 10: 119-10.1186/1471-2458-10-119.CrossRefPubMedPubMedCentral Sundquist J, Johansson S-E, Sundquist K: Levelling off of prevalence of obesity in the adult population of Sweden between 2000/01 and 2004/05. BMC Public Health. 2010, 10: 119-10.1186/1471-2458-10-119.CrossRefPubMedPubMedCentral
14.
go back to reference Micciolo R, Di Francesco V, Fantin F, Canal L, Harris TB, Bosello O, Zamboni M: Prevalence of overweight and obesity in Italy (2001-2008): is there a rising obesity epidemic?. Ann Epidemiol. 2010, 20: 258-264. 10.1016/j.annepidem.2010.01.006.CrossRefPubMed Micciolo R, Di Francesco V, Fantin F, Canal L, Harris TB, Bosello O, Zamboni M: Prevalence of overweight and obesity in Italy (2001-2008): is there a rising obesity epidemic?. Ann Epidemiol. 2010, 20: 258-264. 10.1016/j.annepidem.2010.01.006.CrossRefPubMed
15.
go back to reference McLaren L: Socioeconomic status and obesity. Epidemiol Rev. 2007, 29: 29-48. 10.1093/epirev/mxm001.CrossRefPubMed McLaren L: Socioeconomic status and obesity. Epidemiol Rev. 2007, 29: 29-48. 10.1093/epirev/mxm001.CrossRefPubMed
16.
go back to reference Papas MA, Alberg AJ, Ewing R, Helzlsouer KJ, Gary TL, Klassen AC: The built environment and obesity. Epidemiol Rev. 2007, 29: 129-143. 10.1093/epirev/mxm009.CrossRefPubMed Papas MA, Alberg AJ, Ewing R, Helzlsouer KJ, Gary TL, Klassen AC: The built environment and obesity. Epidemiol Rev. 2007, 29: 129-143. 10.1093/epirev/mxm009.CrossRefPubMed
17.
go back to reference Ashworth M, Armstrong D: The relationship between general practice characteristics and quality of care: a national survey of quality indicators used in the UK Quality and Outcomes Framework, 2004-5. BMC Fam Pr. 2006, 7: 68-10.1186/1471-2296-7-68.CrossRef Ashworth M, Armstrong D: The relationship between general practice characteristics and quality of care: a national survey of quality indicators used in the UK Quality and Outcomes Framework, 2004-5. BMC Fam Pr. 2006, 7: 68-10.1186/1471-2296-7-68.CrossRef
18.
go back to reference Merlo J, Chaix B, Ohlsson H, Beckman A, Johnell K, Hjerpe P, Råstam L, Larsen K: A brief conceptual tutorial of multilevel analysis in social epidemiology: using measures of clustering in multilevel logistic regression to investigate contextual phenomena. J Epidemiol Community Health. 2006, 60: 290-297. 10.1136/jech.2004.029454.CrossRefPubMedPubMedCentral Merlo J, Chaix B, Ohlsson H, Beckman A, Johnell K, Hjerpe P, Råstam L, Larsen K: A brief conceptual tutorial of multilevel analysis in social epidemiology: using measures of clustering in multilevel logistic regression to investigate contextual phenomena. J Epidemiol Community Health. 2006, 60: 290-297. 10.1136/jech.2004.029454.CrossRefPubMedPubMedCentral
19.
go back to reference Larsen K, Merlo J: Appropriate assessment of neighborhood effects on individual health: integrating random and fixed effects in multilevel logistic regression. Am J Epidemiol. 2005, 161: 81-88. 10.1093/aje/kwi017.CrossRefPubMed Larsen K, Merlo J: Appropriate assessment of neighborhood effects on individual health: integrating random and fixed effects in multilevel logistic regression. Am J Epidemiol. 2005, 161: 81-88. 10.1093/aje/kwi017.CrossRefPubMed
20.
go back to reference Hainer V, Hainerová IA: Do we need anti-obesity drugs?. Diabetes Metab Res Rev. 2012, 28 (Suppl 2): 8-20.CrossRefPubMed Hainer V, Hainerová IA: Do we need anti-obesity drugs?. Diabetes Metab Res Rev. 2012, 28 (Suppl 2): 8-20.CrossRefPubMed
21.
go back to reference Srishanmuganathan J, Patel H, Car J, Majeed A: National trends in the use and costs of anti-obesity medications in England 1998-2005. J Public Health. 2007, 29: 199-202. 10.1093/pubmed/fdm013.CrossRef Srishanmuganathan J, Patel H, Car J, Majeed A: National trends in the use and costs of anti-obesity medications in England 1998-2005. J Public Health. 2007, 29: 199-202. 10.1093/pubmed/fdm013.CrossRef
22.
go back to reference Khan LK, Serdula MK, Bowman BA, Williamson DF: Use of prescription weight loss pills among US adults in 1996-1998. Ann Intern Med. 2001, 134: 282-286. 10.7326/0003-4819-134-4-200102200-00011.CrossRefPubMed Khan LK, Serdula MK, Bowman BA, Williamson DF: Use of prescription weight loss pills among US adults in 1996-1998. Ann Intern Med. 2001, 134: 282-286. 10.7326/0003-4819-134-4-200102200-00011.CrossRefPubMed
23.
go back to reference Wild S, Roglic G, Green A, Sicree R, King H: Global prevalence of diabetes - Estimates for the year 2000 and projections for 2030. Diabetes Care. 2004, 27: 1047-1053. 10.2337/diacare.27.5.1047.CrossRefPubMed Wild S, Roglic G, Green A, Sicree R, King H: Global prevalence of diabetes - Estimates for the year 2000 and projections for 2030. Diabetes Care. 2004, 27: 1047-1053. 10.2337/diacare.27.5.1047.CrossRefPubMed
24.
go back to reference Perez-Lopez FR, Larrad-Mur L, Kallen A, Chedraui P, Taylor HS: Gender differences in cardiovascular disease: hormonal and biochemical influences. Reprod Sci. 2010, 17: 511-531. 10.1177/1933719110367829.CrossRefPubMedPubMedCentral Perez-Lopez FR, Larrad-Mur L, Kallen A, Chedraui P, Taylor HS: Gender differences in cardiovascular disease: hormonal and biochemical influences. Reprod Sci. 2010, 17: 511-531. 10.1177/1933719110367829.CrossRefPubMedPubMedCentral
25.
go back to reference Mosca L, Barrett-Connor E, Wenger NK: Sex/gender differences in cardiovascular disease prevention what a difference a decade makes. Circulation. 2011, 124: 2145-2154. 10.1161/CIRCULATIONAHA.110.968792.CrossRefPubMedPubMedCentral Mosca L, Barrett-Connor E, Wenger NK: Sex/gender differences in cardiovascular disease prevention what a difference a decade makes. Circulation. 2011, 124: 2145-2154. 10.1161/CIRCULATIONAHA.110.968792.CrossRefPubMedPubMedCentral
26.
go back to reference Regnault V, Thomas F, Safar ME, Osborne-Pellegrin M, Khalil RA, Pannier B, Lacolley P: Sex difference in cardiovascular risk. J Am Coll Cardiol. 2012, 59: 1771-1777. 10.1016/j.jacc.2012.01.044.CrossRefPubMedPubMedCentral Regnault V, Thomas F, Safar ME, Osborne-Pellegrin M, Khalil RA, Pannier B, Lacolley P: Sex difference in cardiovascular risk. J Am Coll Cardiol. 2012, 59: 1771-1777. 10.1016/j.jacc.2012.01.044.CrossRefPubMedPubMedCentral
27.
go back to reference Galdas PM, Cheater F, Marshall P: Men and health help-seeking behaviour: literature review. J Adv Nurs. 2005, 49: 616-623. 10.1111/j.1365-2648.2004.03331.x.CrossRefPubMed Galdas PM, Cheater F, Marshall P: Men and health help-seeking behaviour: literature review. J Adv Nurs. 2005, 49: 616-623. 10.1111/j.1365-2648.2004.03331.x.CrossRefPubMed
28.
go back to reference Matthiasdottir E, Jonsson SH, Kristjansson AL: Body weight dissatisfaction in the Icelandic adult population: a normative discontent?. Eur J Public Health. 2012, 22: 116-121. 10.1093/eurpub/ckq178.CrossRefPubMed Matthiasdottir E, Jonsson SH, Kristjansson AL: Body weight dissatisfaction in the Icelandic adult population: a normative discontent?. Eur J Public Health. 2012, 22: 116-121. 10.1093/eurpub/ckq178.CrossRefPubMed
29.
go back to reference Peat CM, Peyerl NL, Muehlenkamp JJ: Body image and eating disorders in older adults: a review. J Gen Psychol. 2008, 135: 343-358. 10.3200/GENP.135.4.343-358.CrossRefPubMed Peat CM, Peyerl NL, Muehlenkamp JJ: Body image and eating disorders in older adults: a review. J Gen Psychol. 2008, 135: 343-358. 10.3200/GENP.135.4.343-358.CrossRefPubMed
30.
go back to reference Tudor Hart J: The inverse care Law. Lancet. 1971, 297: 405-412. 10.1016/S0140-6736(71)92410-X.CrossRef Tudor Hart J: The inverse care Law. Lancet. 1971, 297: 405-412. 10.1016/S0140-6736(71)92410-X.CrossRef
31.
go back to reference Shaw M, Dorling D: Who cares in England and Wales? The positive care law: cross-sectional study. Br J Gen Pract. 2004, 54: 899-903.PubMedPubMedCentral Shaw M, Dorling D: Who cares in England and Wales? The positive care law: cross-sectional study. Br J Gen Pract. 2004, 54: 899-903.PubMedPubMedCentral
32.
33.
go back to reference Cox M, Boyle PJ, Davey PG, Feng Z, Morris AD: Locality deprivation and Type 2 diabetes incidence: a local test of relative inequalities. Placing Health Context. 2007, 65: 1953-1964. Cox M, Boyle PJ, Davey PG, Feng Z, Morris AD: Locality deprivation and Type 2 diabetes incidence: a local test of relative inequalities. Placing Health Context. 2007, 65: 1953-1964.
34.
go back to reference Scholes S, Bajekal M, Love H, Hawkins N, Raine R, O’Flaherty M, Capewell S: Persistent socioeconomic inequalities in cardiovascular risk factors in England over 1994-2008: A time-trend analysis of repeated cross-sectional data. BMC Public Health. 2012, 12: 129-10.1186/1471-2458-12-129.CrossRefPubMedPubMedCentral Scholes S, Bajekal M, Love H, Hawkins N, Raine R, O’Flaherty M, Capewell S: Persistent socioeconomic inequalities in cardiovascular risk factors in England over 1994-2008: A time-trend analysis of repeated cross-sectional data. BMC Public Health. 2012, 12: 129-10.1186/1471-2458-12-129.CrossRefPubMedPubMedCentral
35.
go back to reference Kristeller JL, Hoerr RA: Physician attitudes toward managing obesity: Differences among six specialty groups. Prev Med. 1997, 26: 542-549. 10.1006/pmed.1997.0171.CrossRefPubMed Kristeller JL, Hoerr RA: Physician attitudes toward managing obesity: Differences among six specialty groups. Prev Med. 1997, 26: 542-549. 10.1006/pmed.1997.0171.CrossRefPubMed
36.
go back to reference Ogden J, Sidhu S: Adherence, behavior change, and visualization: a qualitative study of the experiences of taking an obesity medication. J Psychosom Res. 2006, 61: 545-552. 10.1016/j.jpsychores.2006.04.017.CrossRefPubMed Ogden J, Sidhu S: Adherence, behavior change, and visualization: a qualitative study of the experiences of taking an obesity medication. J Psychosom Res. 2006, 61: 545-552. 10.1016/j.jpsychores.2006.04.017.CrossRefPubMed
37.
go back to reference Ogden J, Flanagan Z: Beliefs about the causes and solutions to obesity: a comparison of GPs and lay people. Patient Educ Couns. 2008, 71: 72-78. 10.1016/j.pec.2007.11.022.CrossRefPubMed Ogden J, Flanagan Z: Beliefs about the causes and solutions to obesity: a comparison of GPs and lay people. Patient Educ Couns. 2008, 71: 72-78. 10.1016/j.pec.2007.11.022.CrossRefPubMed
Metadata
Title
The relationship between BMI and the prescription of anti-obesity medication according to social factors: a population cross sectional study
Authors
Lynsey Patterson
Frank Kee
Carmel Hughes
Dermot O’Reilly
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2014
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-14-87

Other articles of this Issue 1/2014

BMC Public Health 1/2014 Go to the issue