Anti-obesity drug therapy in clinical practice: Evidence of a poor prescriptive attitude

Francesco Squadrito; Michelangelo Rottura; Natasha Irrera; Letteria Minutoli; Alessandra Bitto; Maria Antonietta Barbieri; Giuseppe Cicala; Anna Mecchio; Giovanni Pallio; Sebastiano Marino; Giacomo Picciolo; Domenica Altavilla; Vincenzo Arcoraci

doi:10.1016/j.biopha.2020.110320

Anti-obesity drug therapy in clinical practice: Evidence of a poor prescriptive attitude

Biomed Pharmacother. 2020 Aug:128:110320. doi: 10.1016/j.biopha.2020.110320. Epub 2020 Jun 2.

Affiliations

¹ Department of Clinical and Experimental Medicine, University of Messina, c/o AOU Policlinico G. Martino, Via C. Valeria Gazzi, 98125, Messina, Italy. Electronic address: fsquadrito@unime.it.
² Department of Clinical and Experimental Medicine, University of Messina, c/o AOU Policlinico G. Martino, Via C. Valeria Gazzi, 98125, Messina, Italy.
³ Department of Biomedical, Dental, Morphological and Functional Imaging Sciences, University of Messina, c/o AOU Policlinico G. Martino, Via C. Valeria Gazzi, 98125, Messina, Italy.

PMID: 32502842
DOI: 10.1016/j.biopha.2020.110320

Abstract

Obesity is a worldwide growing problem for the health care systems and its treatment is strongly recommended. Orlistat, naltrexone/bupropion, and liraglutide are approved for weight loss in Italy in patients with a Body Mass Index (BMI) ≥ 30 kg/m² or ≥ 27 kg/m² with concomitant diseases. However, the prescription of these drugs is significantly low worldwide. General practitioners (GPs) play a key role in the early diagnosis and appropriate management of obesity. The aim of the study was to investigate the management of obesity and the prescriptive attitude of anti-obesity drugs in a general practice setting. All patients registered in lists of 8 GPs with a recorded diagnosis of obesity or BMI values ≥ 30 kg/m² in the period 2017-2018, were recruited. A descriptive analysis of demographic and clinical characteristic was carried out. The Spearman's correlation rank test was applied to identify correlations between BMI and all the variables of interest. Among 1301 obese patients, only 66.1 % had been diagnosed and 29.4 % had no registered BMI value. Patients with recorded BMI, were overweight (7.8 %) or in the obesity class I (38.8 %), class II (14.1 %), and class III (7.1 %), respectively. The obese patients (class 1-3) were older [66 (55-76) vs 49 (32-59); p < 0.01], and had more concurrent diseases [5 (3-8) vs 4 (2-6); p < 0.01] than patients who reached a BMI < 30 Kg/m². Moreover, most of obese were high cardiovascular risk (HCVr) patients (67.0 % vs 31.9 %; p < 0.01). The BMI was directly related to age (r_s 0.14; p < 0.01), diabetes (r_s 0.19; p < 0.01), hypertension (r_s 0.14; p < 0.01), heart failure (r_s 0.09; p < 0.01), HCVr (r_s 0. 12; p < 0.01) and number of comorbidities (r_s 0.08; p = 0.01). No prescriptions of orlistat or naltrexone/bupropion were found. Liraglutide was prescribed only in 7 patients because of the concomitant presence of diabetes. Our results suggest a low adherence to guide line recommendations for obesity management and confirm an under-prescription of anti-obesity drugs in Italy.

Keywords: General practice; Obesity; Pharmacotherapy; Prescription.

Publication types

Observational Study

MeSH terms

Adult
Aged
Anti-Obesity Agents / therapeutic use*
Attitude of Health Personnel*
Body Mass Index
Drug Prescriptions
Drug Utilization
Female
General Practitioners / psychology*
Guideline Adherence
Health Knowledge, Attitudes, Practice*
Health Services Misuse
Humans
Male
Middle Aged
Obesity / diagnosis
Obesity / drug therapy*
Practice Guidelines as Topic
Retrospective Studies

Substances

Anti-Obesity Agents