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

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.

Racial and Ethnic Disparities in Financial Barriers Among Overweight and Obese Adults Eligible for Semaglutide in the United States

“…It is possible that a provider's unconscious biases may influence him or her into believing that patients of certain races and ethnicities are less likely to afford, understand, or accept the use of certain classes of medications. 13 Limited use of AOMs may reflect limited discussions between patients and their providers and poor patient–provider communication. 14 Although the effect of semaglutide has been proven in large clinical trials, translation of evidence to clinical practice is important for increasing the uptake of semaglutide and reduce racial and ethnic disparities in obesity.…”

Effectiveness and predictors of weight loss response to phentermine plus lifestyle modifications among youth in a paediatric weight management clinical setting

“…47 In our setting, these include healthcare disparities, cultural barriers, previous weight loss attempts and patient/family receptiveness, among others. 14 It should be noted that obesity guidelines recommend AOMs always be used in conjunction with LSM and, therefore, identifying clinical effectiveness and predictors of response from phentermine alone may have less clinical utility. 42,48 We do hope that this work provides a framework for future investigations, including clinical trials, which would require curation of additional datasets including the aforementioned factors.…”

“…Participants included patients in the paediatric weight management clinic who did not opt out of having their EHR reviewed for the purposes of research via the Consent for Services form that all patients/families complete. In a recent study using data from patients treated in this clinic, the percentage of youth/families opting out of research was ~1% 14 . Additional inclusion criteria included age < 18 years old when phentermine was first prescribed, treated in the paediatric weight management clinic for ≥1.5 months after this time and ≥1 follow‐up visit during the study period.…”

“…In a recent study using data from patients treated in this clinic, the percentage of youth/families opting out of research was 1%. 14 Additional inclusion criteria included age < 18 years old when phentermine was first prescribed, treated in the paediatric weight management clinic for ≥1.5 months after this time and ≥1 follow-up visit during the study period.…”

Social and Structural Determinants of Health and Social Injustices Contributing to Obesity Disparities

“…Obesity treatment among Black and Hispanic children is especially challenging due macro-level and micro-level factors that are impacted by social and structural determinants of health [42]. While there are effective treatments for childhood obesity, Black and Hispanic children tend to have poorer outcomes than their White counterparts [35,43,44]. Less access to healthful foods, fewer safe places to be physically active, unmet social needs, low parental socioeconomic status and differing social expectations regarding weight status are key factors that may drive the poorer treatment outcomes among Black and Hispanic children with obesity [12,43,[45][46][47][48].…”