Patient Preferences for Attributes of Health Canada Approved Weight Loss Medications Among Adults Living with Obesity in Canada: A Qualitative Study

Abstract

Purpose Obesity is a complex disease with negative impacts on physical and mental health. The treatment of obesity is an area where shared decision making and patient preferences play an important role. Recommendations surrounding weight loss medications are evolving and only recently, with the publication of the 2020 Canadian Obesity Management Clinical Guidelines, pharmacotherapy has become a recommended alternative for obesity management. Guidelines recommend three medications: orlistat, liraglutide, and naltrexone/bupropion. This study sought to identify medication attributes relevant to patients starting pharmacotherapy for weight management. Patients and Methods Semi-structured focus groups and interviews were conducted with Canadian residents who were ≥18 years of age and were living with obesity (body mass index [BMI] ≥30kg/m 2 or ≥27kg/m 2 with adiposity-related complications). Sessions were conducted virtually, audio recorded, and transcribed. Two team members used a combination of inductive and deductive coding to independently code the data. A final coding template was agreed upon through discussion. Results A total of 21 individuals participated (85.7% female, 76.2% ≥40 years of age) with the average BMI being 44.3 kg/m 2 . Participants touched upon many attributes which were categorized into five categories: 1) cost, 2) regimen, 3) side effects, 4) benefits, and 5) non-medication attributes. Cost of medications, lack of coverage by insurance companies, and stigma were identified as major barriers to accessing medications. There was consensus in the desire for a simple regimen, however there was heterogeneity among opinions on tolerability of side effects, desired benefits, and route of administration. Conclusion This study identified attributes that influenced patient’s decisions when considering a new anti-obesity medication. Understanding these attributes can assist clinicians in shared decision-making. This study highlighted the stigma that is prevalent among providers and the need for education. Further research should be conducted to understand the tradeoffs patients in our study make between the identified attributes.

Obesity management from the perspectives of people living with obesity in Canada: A mixed‐methods study

“…Finally, the financial burden of obesity interventions remains a key challenge for PwO. Obesity pharmacotherapy is not covered by federal or provincial drug programmes and employers provide limited health insurance coverage 14,17,28 . Other adjunctive treatments and interdisciplinary professional support (e.g., dietitians, exercise physiologists) are often similarly inaccessible 14 .…”

“…Obesity pharmacotherapy is not covered by federal or provincial drug programmes and employers provide limited health insurance coverage. 14,17,28 Other adjunctive treatments and interdisciplinary professional support (e.g., dietitians, exercise physiologists) are often similarly inaccessible. 14 While bariatric surgery may often be covered, its accessibility and effectiveness are impacted by years-long waiting lists and reduced postoperative follow-up.…”