Sociodemographic, Clinical Factors Associated with Semaglutide Initiation in Adults with Obesity
For adults with obesity but no diabetes diagnosis, researchers searched for the key factors leading to semaglutide initiation.
Researchers found that use of common medications, insurance plan structure, employer industry type, and sex all contributed to semaglutide initiation for patients with obesity and commercial insurance but no diabetes. Owing to the sociodemographic, health care, and clinical factors associated with semaglutide initiation, researchers’ findings highlighted continued inequities regarding medication access for glucagon-like peptide-1 (GLP-1) receptor agonists, according to data published in JAMA Network Open.1
“While antiobesity medications have the potential to reduce inequities in obesity burden and treatment, they may not be reaching subpopulations disproportionately impacted by the disease, such as those with low socioeconomic status and Black and Hispanic individuals,” they wrote. “Patient access to GLP-1 receptor agonists may vary by individual factors; one key determinant is insurance coverage, and there is scant data on variations in access by insurance source and structure.”
Stemming from the approval of semaglutide (Wegovy) for treating obesity in 2021, GLP-1s have seen a 300% increase from 2018 to 2023. | image credit: K KStock / stock.adobe.com
While the first GLP-1 for treating obesity was approved in 2014, these medications have seen a much more substantial boom in the past few years. Stemming from the approval of semaglutide (Wegovy, Ozempic) for treating obesity in 2021, GLP-1s have seen a 300% increase from 2018 to 2023.2 From continued success in treating weight loss to further indications for diabetes and cardiovascular disease,3 6% of the current US population reported that they are taking some type of GLP-1 receptor agonist.1
However, as the apparent increase in GLP-1 prescriptions persists, industry experts are attempting to navigate a challenging rise in demand. According to the FDA, as of December 19, 2024, 3 GLP-1 medications—dulaglutide (Trulicity), semaglutide, and liraglutide (Victoza)—are in a drug shortage.4 Furthermore, only 1 in 5 patients with a GLP-1 prescription reported a diagnosis of obesity from their physician, highlighting a notable issue regarding access as some populations struggle significantly more than others to receive a GLP-1 prescription.
READ MORE: Q&A: Factors Showing Tirzepatide is More Beneficial Than Semaglutide | ASHP Midyear
“We sought to examine factors associated with incident semaglutide usage among individuals with obesity without diabetes,” wrote the authors.1 By focusing on individuals with obesity but without diabetes, researchers aimed for more successful study results since several beneficiaries of GLP-1s receive prescriptions both for weight loss and diabetes. “Characterizing current users of these medications without diabetes will aid in understanding how to provide effective obesity care to those in need,” they continued.
All included study participants were US adults over 18 with obesity diagnosis between June 5, 2021, and July 1, 2022. Individuals were excluded if they had a previous antiobesity medication prescription, bariatric surgery, or a diabetes-related claim within a year before obesity diagnosis. They then used Shapley Additive Explanation (SHAP) values to identify the top factors leading to semaglutide initiation. A total of 97,456 participants (59.6% women; 27.3% aged 45-54) were included in the study.
“The factor with the highest SHAP value for semaglutide initiation was sex, with female individuals being more likely to be classified as initiating semaglutide. Use of common medication classes such as antidepressants, thyroid or hormone medications, amphetamines, anticonvulsants, and adrenal medications were identified as important in the model. Demographic and economic factors, including age, region, and insurance plan type, as well as employee status and index month, were also identified as important,” wrote authors of the study.1
Some of the key takeaways from researchers’ findings were that women were more than twice as likely to initiate a semaglutide prescription. They also found that odds of semaglutide initiation were significantly higher towards the latter half of the study period, compared with June 2021.
From age and sex to simultaneous prescriptions and insurance plan structures, there are a significant number of factors that affect which individuals will initiate a prescription for semaglutide. With their success in identifying specific subpopulations who may struggle with access compared to others, researchers hope that their findings will inform clinicians on the patients more or less likely to struggle for obesity treatment.
“For policymakers, the results underscore the need to address structural barriers, such as expanding insurance coverage of weight loss medications to promote access to effective obesity treatments. Overall, this study highlights the need to investigate antiobesity medication use in varied populations as the obesity treatment landscape changes with the introduction of novel treatments,” concluded authors of the study.1
READ MORE: Obesity Management Resource Center
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