Friday, March 1, 2024

Implied bias against patients with obesity hampering their treatment

Implicit bias in the treatment of patients with obesity, and a reluctance to manage the condition as a chronic disease is hampering access to effective medications, a consultant endocrinologist has said

Dr Jean O’Connell of St Vincent’s Hospital in Dublin also told IMT that the strict criteria for the reimbursement of obesity drugs in Ireland means that the majority of those eligible for such treatments will have to pay out-of-pocket, while those who can’t afford them will be left untreated.

Dr O’Connell, who is also a bariatric physician and a member of the Association for the Study of Obesity on the Island of Ireland (ASOI), made the comments as huge global demand for drugs like semaglutide (trading as Ozempic) is driving a shortage in supply.

Originally used to treat type 2 diabetes, in recent years the evolution of Ozempic has made it highly effective in also treating obesity.

Since January 2022 the drug has been licensed here for the treatment of obesity, in a higher-dose form known as Wegovy. However, when prescribed for the treatment of obesity it is available for reimbursement here.

Another less effective drug known as Saxenda is currently the only medicine for treating obesity that is reimbursed by the HSE.

“Unlike other chronic diseases, medications for obesity are only reimbursed under very restricted circumstances,” Dr O’Connell said.

“The majority of patients for whom it would be appropriate to prescribe to treat obesity will not be eligible for reimbursement. So they often won’t be able to afford to pay for the medications because they’re not covered either on the medical card or the drug payment scheme.”

Last June the ASOI criticised a letter to doctors and pharmacists from the Medical Council, which they believe implied that prescribing semaglutide is not appropriate for weight management, and that, in light of limited supply of the drug, patients with diabetes should be given priority.

A statement from the ASOI said it had “requested clarification with regard to the statement that ‘medical practitioners are expected to use resources appropriately and responsibly’, suggesting that prescribing semaglutide for obesity (without diabetes) is inappropriate and irresponsible.

“Additional advice that practitioners should be mindful of the ‘risk to patient safety arising from medicine supply issues’ evokes an alarmist tone and implies a disregard to patients with diabetes if doctors prescribe semaglutide appropriately to those with obesity,” the statement added.

Dr O’Connell told IMT: “I don’t think it’s helpful to think of one disease being more deserving than another disease.” She believes that a subconscious or implicit bias may be playing a part in the way come clinicians treat obesity.

“In healthcare settings, it (implicit bias) is particularly disappointing because we pride ourselves on practicing evidence-based medicine, and if you practice evidence-based medicine, these medications are very effective and they’re very safe.

“We should be approaching them that way and also approaching obesity with the mindset of approaching a chronic disease, because it is a chronic disease and to recognise it as such by the Department of Health, but unfortunately it’s still not managed the same way as other chronic diseases.”

Meanwhile, according to O’Connell, St Vincent’s Obesity and Bariatric surgery centre is seeing new patients present with complications arising from bariatric surgeries carried out abroad ‘every week’.

While the most serious complications tend to occur quite soon after surgery, some patients present with issues months, or even up to two years, after the procedure.

“We feel very bad for those patients because we know that nobody would choose to go abroad to have surgery if they could have it at home, if the access was there, if we didn’t have such a long waiting list.

“And so really what we have to focus on is trying to increase access to services, to increase funding of the model of care and increase specialists in the centres.”

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