Anti-obesity medication prescriptions by race/ethnicity and use of an interpreter in a pediatric weight management clinic

Eric M Bomberg; Elise F Palzer; Kyle D Rudser; Aaron S Kelly; Carolyn T Bramante; Hilary K Seligman; Favour Noni; Claudia K Fox

doi:10.1177/20420188221090009

Anti-obesity medication prescriptions by race/ethnicity and use of an interpreter in a pediatric weight management clinic

Ther Adv Endocrinol Metab. 2022 Apr 11:13:20420188221090009. doi: 10.1177/20420188221090009. eCollection 2022.

Authors

Eric M Bomberg¹, Elise F Palzer², Kyle D Rudser³, Aaron S Kelly³, Carolyn T Bramante³, Hilary K Seligman⁴, Favour Noni⁵, Claudia K Fox³

Affiliations

¹ Center for Pediatric Obesity Medicine, Department of Pediatrics, Medical School, University of Minnesota, 717 Delaware Street SE, Room 370, Minneapolis, MN 55414, USA.
² Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA.
³ Center for Pediatric Obesity Medicine, Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, MN, USA.
⁴ Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
⁵ University of Minnesota, Minneapolis, MN, USA.

Abstract

Background: Race/ethnicity and low English proficiency healthcare disparities are well established in the United States. We sought to determine if there are race/ethnicity differences in anti-obesity medication (AOM) prescription rates among youth with severe obesity treated in a pediatric weight management clinic and if, among youth from non-primary English speaking families, there are differences in prescriptions between those using interpreters during visits versus not.

Methods: We reviewed electronic health records of 2- to 18-year-olds with severe obesity seen from 2012 to 2021. Race/ethnicity was self-report, and AOMs included topiramate, stimulants (e.g. phentermine, lisdexamfetamine), naltrexone (±bupropion), glucagon-like peptide-1 agonists, and orlistat. We used general linear regression models with log-link to compare incidence rate ratios (IRRs) within the first 1 and 3 years of being followed, controlling for age, percent of the 95th BMI percentile (%BMIp95), number of obesity-related comorbidities (e.g. insulin resistance, hypertension), median household income, and interpreter use. We repeated similar analyses among youth from non-primary English speaking families, comparing those using interpreters versus not.

Results: 1,725 youth (mean age 11.5 years; %BMIp95 142%; 53% non-Hispanic White, 20% Hispanic/Latino, 16% non-Hispanic black; 6% used interpreters) were seen, of which 15% were prescribed AOMs within 1 year. The IRR for prescriptions was lower among Hispanic/Latino compared to non-Hispanic White youth at one (IRR 0.70; CI: 0.49-1.00; p = 0.047) but not 3 years. No other statistically significant differences by race/ethnicity were found. Among non-primary English speaking families, the IRR for prescriptions was higher at 1 year (IRR 2.49; CI: 1.32-4.70; p = 0.005) in those using interpreters versus not.

Conclusions: Among youth seen in a pediatric weight management clinic, AOM prescription incidence rates were lower in Hispanics/Latinos compared to non-Hispanic Whites. Interpreter use was associated with higher prescription incidence rates among non-primary English speakers. Interventions to achieve equity in AOM prescriptions may help mitigate disparities in pediatric obesity.

Keywords: anti-obesity agents; healthcare disparities; limited english proficiency; obesity; pediatric obesity.

Abstract

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