Perceptions and Comfort Status in Prescribing Anti-Obesity Medications: A Multi-Center Survey among Gastroenterologists and Primary Care Physicians

Introduction: Given the relationship between excess adiposity, current treatment strategies, and digestive health, gastroenterologists (GIs) are increasingly being asked to participate in the management of obesity. Novel anti-obesity medications (AOMs) have proven to be an effective adjunct to lifestyle modifications, with new gut hormone analogues (GLP-1/GIP agonists) delaying gastrointestinal motility and reducing appetite. Perceptions regarding AOMs among GIs in comparison to primary care physicians (PCPs) are not well defined. Methods: We conducted a survey-based study among GIs and PCPs at three large academic institutions to assess perceptions and attitudes regarding obesity management and AOMs. The online survey consisted of 24 questions assessing practice makeup, patterns and comfort in obesity care. It was distributed electronically over a 24-month period to GI and PCP faculty at three academic institutions. Five-point Likert items were analyzed as continuous variables by an independent t-test and χ(2)-test was used for comparison of proportions (Table 1). Results: The total response rate was 27% (103/372), with 25% (34/137) for PCPs and 29% (69/235) for GIs. 46% of survey respondents were female. Although the number of GIs and PCPs who reported caring for patients with obesity was similar (64.1% vs 77%, P=0.18), there was a significant difference in weight loss counseling during visits (24% vs 41%, P=0.041), despite 93% of GIs reporting this was important. Of GIs who did discuss weight loss routinely, only 19% counseled on AOMs compared to 59% of PCPs (P< 0.001). Although 90% of GIs believed AOMs were effective, only 65% believed risks outweighed benefits, and about half (52%) believed that GIs should prescribe them. Only 12% of GIs felt comfortable prescribing AOMs compared to 32% of PCPs (P=0.019), most commonly citing lack of familiarity and training as barriers (65% vs 32%, P=0.002; 26% vs 10%, P=0.031). Conclusion: Recent guidelines have suggested GIs consider AOMs when caring for patients with obesity; however GIs perceptions regarding these recommendations have not been assessed. Our survey-based study notes in comparison to PCPs, GIs receive less training and are more wary of AOMs despite caring for similar populations and believing obesity management is an important consideration in clinical practice. Continued education and refinement of obesity management curricula are needed to address rising rates of metabolic disease and associated poor health outcomes. Table 1. - GI and PCP Survey Responses Regarding Obesity Management and AOMs Characteristic GI, n= 691 PCP, n= 341 P-value2 Sex 0.004 Female 24 (35%) 23 (68%) Male 43 (62%) 11 (32%) Decline to answer 2 (2.9%) 0 (0%) Race 0.57 Asian or Pacific Islander 15 (22%) 10 (29%) Black or African American 3 (4.3%) 3 (4.3%) Hispanic or Latino 3 (4.3%) 2 (5.9%) White 40 (58%) 20 (59%) Other 2 (2.9%) 1 (2.9%) Decline to answer 6 (8.7%) 0 (0%) Position < 0.001 Trainee (Fellow/Resident) 19 (28%) 21 (62%) Junior Attending (< 10 years from fellowship) 29 (42%) 5 (15%) Senior Attending (>10 years from fellowship) 13 (19%) 8 (24%) Decline to answer 8 (12%) 0 (0%) % patients overweight or obese 0.18 Less than 25% 3 (4.3%) 0 (0%) 25% to 50% 23 (33%) 8 (24%) 50% to 75% 41 (59%) 22 (65%) Greater than 75% 2 (2.9%) 4 (12%) How often discuss weight/weight loss 0.041 At most routine appointments 16 (23%) 16 (47%) At most routine appointments and new problem visits 25 (36%) 10 (29%) Rarely (I do not routinely discuss it, but have mentioned it in the past) 28 (41%) 8 (24%) Obesity management plan includes Diet/exercise counseling 64 (93%) 34 (100%) 0.17 Medications 13 (19%) 20 (59%) < 0.001 Procedure/surgery referral 25 (36%) 14 (41%) 0.63 Specialist referral 53 (77%) 25 (74%) 0.71 Have prescribed medications solely for weight loss < 0.001 Yes 13 (19%) 20 (59%) No 56 (81%) 14 (41%) Reason have not prescribed AOM Not familiar with medications 45 (65%) 11 (32%) 0.002 Insurance approval/cost 9 (13%) 16 (47%) < 0.001 I believe weight loss medications help patients lose weight 0.47 Agree 62 (90%) 28 (82%) Disagree 2 (2.9%) 1 (2.9%) Neutral 5 (7.2%) 5 (15%) I believe weight loss medication benefits outweigh the adverse effects 0.29 Agree 45 (65%) 17 (50%) Disagree 3 (4.3%) 2 (5.9%) Neutral 21 (30%) 15 (44%) I feel comfortable prescribing these medications on a regular basis 0.019 Agree 8 (12%) 11 (32%) Disagree 48 (70%) 15 (44%) Neutral 13 (19%) 8 (24%) Received training in Prescribing weight loss medication 7 (10%) 9 (26%) 0.031 Nutrition 33 (48%) 5 (15%) 0.001 Weight Management 16 (23%) 10 (29%) 0.49 1n (%).2Fischer's exact test; Pearson's chi-squared test.