Abstract 14413: Contemporary Prevalence, Comorbidity Burden, and Treatment of Overweight and Obesity: Insights From the Multicenter Mass General Brigham Healthcare System
John W Ostrominski, Austen M Smith, Ozan Unlu, David J Zelle, Heather Baer, Michela Tucci, Anthony Fabricatore, Briain O Hartaigh, Joshua Toliver, Wojciech Michalak, Kelly Olsson, Christopher P Cannon, Caroline Apovian, Benjamin Scirica, Alexander J Blood- Physiology (medical)
- Cardiology and Cardiovascular Medicine
Background: Real-world evidence is critical to identify treatment gaps and inform healthcare service design, but contemporary anti-obesity medication (AOM) use patterns are sparsely reported.
Aims: To describe the prevalence of obesity/overweight, evidence-based obesity-related conditions (ORCs), and AOM use among eligible patients, with a focus on cardiovascular disease (CVD).
Methods: In this cross-sectional analysis of the multicenter Mass General Brigham healthcare system spanning 2018-2022, we identified all adult patients eligible for AOM (BMI 27-29.9 kg/m 2 with ≥1 ORC or BMI ≥30 kg/m 2 ). The prevalence of ORCs was ascertained using administrative codes and available EHR data. Prescription of FDA-approved AOM by BMI category, number of ORCs, number of key CVD risk factors, and the presence of prior MACE were also evaluated.
Results: Of 2,922,522 individuals who met inclusion criteria, 998,234 (34%) were eligible for AOM (mean age, 49 years; 53% female). Of these, 30%, 41%, 18%, and 11% had a BMI (kg/m 2 ) of 27-29.9, 30-34.9, 35-39.9, and ≥40, respectively. Prior metabolic/bariatric surgery was seen in 2.3%. Musculoskeletal disorders (54%), dyslipidemia/hyperlipidemia (35%), and hypertension (32%) were the most common ORCs, with ≥2 ORCs observed in 58%. Prescription of any FDA-approved AOM was observed in only 1.2% of all eligible patients. Liraglutide 3.0 mg (58% of all AOM) was the most prescribed AOM. AOM prescriptions increased modestly with higher BMI, ORC burden, and number of CVD risk factors ( Figure ). Among those with prior MACE (11%), 1.5% (1.0% if without T2DM) were prescribed FDA-approved AOM.
Conclusions: Although more than 1 in 3 contemporary patients in a large healthcare system are eligible by guidelines and FDA labeling, AOM prescription remains exceedingly low, even among high-risk persons with severe obesity and established CVD. Novel care delivery pathways are needed to accelerate closure of these considerable implementation gaps.