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In-depth patient insights in obesity highlight the need for a holistic, individualised approach to therapy
Nov 13, 2024
With the recent and ongoing wave of innovation in anti-obesity medication, obesity as a therapy area has re-entered the spotlight. Questions about efficacy, long-term effectiveness and reimbursement of the new therapies has drawn renewed attention to challenges of effective long-term weight loss and the barriers patients face in achieving this. In order to maximise benefits from clinical innovation for patients and healthcare systems alike, these barriers must be understood and addressed.
IQVIA collaborated with the Obesity Action Coalition (OAC) to develop deeper insights into the experience of people living with obesity. These insights are based on in-depth interviews conducted with a sample of ten patients based in the US, the UK, and Spain and suffering from obesity class I (BMI 30.0 – 24.9) or class II (BMI 35.0 – 39.9). The interview partners therefore fall below the threshold of obesity class III (BMI above 40) but do fall into the category of people for whom medical interventions including lifestyle adjustments, medication, or bariatric surgery may be considered.
An IQVIA analysis of social media1 found, not surprisingly, a significant spike in the volume of obesity discussions with the advent of the new anti-obesity pharmacotherapies, both among HCPs and potential patients as well as the general public. HCPs in particular were found to engage with the pros and cons of the new therapies and to follow clinical developments. Among potential patients and the general public, the discussion is more wide-ranging but characterised by a lag behind current clinical developments. There is also considerable variation in the quality and maturity of contributions, and this does affect patients’ and their social environment’s attitudes, not always in a constructive manner.
People struggling with obesity feel let down by the healthcare system
While many HCPs on social media display high levels of engagement with recent clinical developments, this is not necessarily the case for the HCPs many people struggling with obesity encounter.
Among the people interviewed, a common theme is feeling let down by the healthcare system and not being taken seriously by healthcare professionals. GPs and other primary care physicians are often the first port of call and can be gatekeepers when it comes to referral to other professionals like nutritionists or obesity specialists. However, a frequently reported experience is that GPs will tell patients to lose weight but are unable or unwilling to either refer the patient to a specialised professional, or engage with them to identify individual barriers to weight loss and develop a tailored approach. Since bodyweight issues frequently go back to childhood or adolescence, most people already have a history of unsuccessfully trying to manage their weight and being either dismissed or given generic diet advice is unlikely to be helpful and may even exacerbate the situation.
It is also not unusual for doctors to dismiss any reported symptoms as caused by excess weight and not to investigate further, thereby running the risk of overlooking other health conditions – in the words of one interviewee, “seems like everything is about or caused by obesity”.
In addition to the physical impact of obesity, interviewees also stressed the impact on their mental health. Self-stigma, low self-esteem, guilt and disgust at what they perceive as their personal failure to manage their weight, depression, and anxiety are commonly mentioned and contribute to the lack of self-efficacy often experienced by obesity patients. These feelings of self-stigma and self-blame are often reinforced by encounters with unsupportive healthcare professionals as well as the wider society. To break through this cycle of self-blame and failure to implement lasting changes, psychological support should be an integral part of any treatment regimen.
However, those who do report progress also report the positive impact the right kind of interaction can have. One interview partner reported being inspired by his neurologist who started running at 55 and achieved significant weight loss. Another discussed the relief of finding “the first doctor who ever listened to me”, having her symptoms taken seriously and finally being prescribed medication for a condition unrelated to obesity. Examples like these illustrate the need for an individualised approach if long-term therapeutic effects are to be achieved.
Reluctance to consider medication and participation in clinical trials
Although respondents struggle with long-term weight loss, there is a reluctance to consider medication. Financial considerations are a major factor since the new anti-obesity medications are frequently not covered by insurance, but there are also major concerns about potential side effects and one participant experienced side effects serious enough to discontinue treatment. There is also a strong perception that medication is a “last resort” only for severely obese patients or those with comorbidities.
The reluctance of patients to consider medication as a viable option which applies to them also reflects the dismissive attitude of HCPs as well as the wider society which tends to regard obesity as a personal failing rather than a condition deserving the attention of medical professionals, a view that has to a degree been internalised by the patients themselves.
Similar concerns also apply to participating in clinical trials. In particular, patients are concerned about the risk / benefit ratio since they feel that their current health status is not that bad and that medication might leave them worse off. While the idea of losing weight is very attractive, especially to people who have struggled with obesity for decades, the worry about possible side effects is a major deterrent, as is the potential need to travel. Time commitments is also a consideration since many people cannot or are unwilling to take time off work. Potential participants are also keen to make a fully informed decision based on detailed information about the medication being tested, possible side effects, expected outcomes, and trial logistics.
A comprehensive and holistic approach is needed
In order to successfully tackle obesity, a comprehensive and holistic approach is needed in which the novel anti-obesity medications have a crucial, but not exclusive part to play. A range of further measures is needed, including, but not limited to:
- Comprehensive education and awareness campaigns are needed in multiple directions:
- Social media is a major source of information for many but often of questionable quality. Improving quality and maturity of the discussion can be a lever to empower patients.
- More education and awareness is also needed for HCPs, particularly GPs and other primary care physicians, with a focus on the need for an individualised approach to tackling obesity
- Ongoing clinical development will require large numbers of participants in clinical trials as well as Real World studies. In order to motivate people to participate, targeted education campaigns for HCPs and patients are needed, ideally developed in collaboration with patient advocacy groups to ensure patients’ concerns are adequately addressed.
- Patient support programmes can be a crucial building block in a holistic approach to tackling obesity. Pharma should consider funding such programmes to enhance the value proposition of the new treatments vis à vis payers and policy makers.
- Healthcare guidelines will have to be updated to reflect the need for an individualised approach to identify barriers to weight loss success, include timely referrals to specialists, and provide psychological and mental support.
- Improving the side effect, or tolerability to efficacy ratio, has already been identified as the next frontier for clinical development in obesity2. The interview participants’ experience of and concern about potential side effects underlines the need for this approach, especially for patient cohorts in the moderate obesity categories.
1 From Post to Prescription: How is Social Media shaping the conversation on Obesity and on Pharmacotherapy for Obesity? IQVIA Blog Oct 9, 2024
https://www.iqvia.com/locations/emea/blogs/2024/10/from-post-to-prescription
2 Tackling tolerability: The next challenge facing obesity therapies. IQVIA Blog Oct 16, 2024
https://www.iqvia.com/locations/emea/blogs/2024/10/tackling-tolerability-the-next-challenge-facing-obesity-therapies