Medications Only Work When You Take Them!Tuesday, January 3, 2023
Now that we have medications for managing obesity that are safer and more effective than ever before, the issue of how to get patients to actually take them deserves more attention.
Generally speaking, most people do not like taking medications, which is why the issue of adherence is not unique to patients with obesity. In fact, most people don’t take medications exactly how or for how long their doctor has prescribed them (I certainly used to belong to that club).
Thus in many ways, adherence to anti-obesity medications (AOMs) is not far worse than to medications in general, which may come as a bit of a surprise, given that the long-term use of AOMs may face more hurdles than other medications.
Thus, one of the most common reasons suggested for why people don’t stick with their AOMs is cost. While this may sound obvious, we should remember that many patients don’t stick with their prescription meds even when these are fully covered by their health plans (e.g. statins or anti-hypertensives).
Another argument often brought up in this regard, is that patients don’t look at obesity as a chronic disease requiring long-term treatment. Again, while this is certainly true, as noted above, adherence to medications for other (well-established) chronic diseases is not much better (often no more than three to six months).
It is also suggested that patients discontinue their AOMs because they are not meeting their (often unrealistic) weight loss goals. However, given that these medications take months before patients achieve their maximum weight-loss (never mind the time it takes to up-titrate to the recommended dose), this does not explain why most patients stop their meds only a couple of weeks into the treatment, i.e. long before they can expect to see the maximum effect or reach their weight-loss plateau. In fact, most patients never seek or fill a second prescription.
I also often hear the notion that patients come off their AOMs because weight is easily monitored and patients can directly see the effect (or lack of it), which is certainly different for statins or ASS. Again, we don’t see much better adherence in patients with other conditions where patients can directly experience the effect of their medications (e.g. medications for chronic pain).
The fact is that non-adherence is not unique to AOMs but of course as relevant to their use as for any other medications for chronic conditions.
This warrants that we familiarise ourselves with the rather extensive body of literature on the science of adherence, a topic that has interested me since back in the days when I worked in my hypertension clinic, trying to get my patients to take their anti-hypertensive meds.
In some ways it does seem that I may have come full circle in having to once-again revisit this topic 30 years later.