Click to Enlarge: With the U.S. military facing rising obesity among active component servicemembers, the DoD authorized coverage of weight loss medications in 2018. Source: Defense Health Agency MSMR
BETHESDA, ME — With the U.S. military facing rising obesity among active component servicemembers, the DoD authorized coverage of weight loss medications in 2018.
A recent study published in the DHA’s Medical Surveillance Monthly Report sought to evaluate prescription prevalence within that cohort. Researchers from the Uniformed Services University of the Health Sciences in Bethesda, MD, and the Armed Forces Health Surveillance Branch in Silver Spring, MD, conducted a retrospective cohort study to analyze data from active-component personnel from January 2018 through June 2023.1
The study used data from the Defense Medical Surveillance System to determine prescription period prevalence of weight loss medication, while also considering data on demographics, body mass index and history of diabetes.
Results indicated a 100-fold increase in the prescription period prevalence of weight-loss agents in the active component from their initial authorization date. The authors advised that demographics associated with higher prescription period prevalence were non-Hispanic Black race and ethnicity, female sex and older age.
“Servicemembers in the health care occupations and the Navy had higher prevalence compared to other service branches and occupations,” they pointed out. “The findings indicate a significant rise in the period prevalence of weight loss prescriptions over time. Further research is recommended to assess the effectiveness, safety and use in austere military environments.”
During the time period studied, the prevalence increased from 1.2 to 104.1 per 100,000 servicemembers, the researchers reported, explaining, the “use of weight loss medications will likely continue to increase due to the ongoing obesity epidemic in the U.S. Further study evaluating their real world effectiveness in weight management and safety for use among service members in austere and deployed environments should be considered.”
They noted the prevalence of obesity among active component service-members rose from 16.1% in 2018 to 18.8% in 2021, while the combined prevalence of both obesity and overweight increased from 65.5% in 2018 to 67.3% in 2021.
“Obesity within military ranks not only compromises readiness and functional capabilities but also correlates with various musculoskeletal injuries and mental health disorders, leading to increased health care provision,” according to the article.
Background information noted that, in 2018, the Defense Health Agency added four weight loss agents (phentermine, benzphetamine, diethylpropion and phendimetrazine) to the TRICARE Formulary, following authorization from the 2017 National Defense Authorization Act. In addition, the coverage of brand name and specially ordered medication (nonformulary) with prior authorization was expanded to include approved long-term therapies: liraglutide, lorcaserin, naltrexone/bupropion, orlistat and phentermine/topiramate.
In 2021, semaglutide, a GLP-1 receptor agonist originally developed for diabetes management, was included in the list of covered medications following U.S. Food and Drug Administration approval.
“While the DHA approved the agents for weight management, consensus indicates these agents remain adjunctive to a comprehensive lifestyle intervention, and prescribers must consider their compatibility with an individual servicemember’s professional duties and personal lifestyle,” according to the study.
The current joint Department of Veterans Affairs and Department of Defense Clinical Practice Guidelines for weight loss medication administration require that patients start lifestyle modifications (i.e., physical training programs and reduced caloric intake) prior to initiating a weight loss medication. After 12 weeks of phentermine use, or in the presence of a contraindication to its use, a patient may be moved to a nonformulary weight loss agent.
The MSMR study documented a substantial increase in the number of monthly prescriptions of weight loss agents among ACSM since their initial approval in September 2017, with a fourfold increase in prescribing rates, starting in 2022. “Phentermine consistently constituted the largest number of prescriptions throughout the study period, which is similar to previous studies of weight loss medication use in civilian populations,” the authors wrote. “The introduction of semaglutide following FDA approval in June 2021, however, resulted in increases in that agent’s prevalence, but its increase is not consistent with linear adoption patterns in the general U.S. population, and may be a result of the sequential process of obtaining semaglutide for weight loss in the military and inter-service variability in prescribing practices. Alternatively, such results may demonstrate secondary effects on prescribing practices and treatment of obesity as a chronic disease as obesity prevalence increases within the Armed Forces and service members and providers become more aware of treatment options involving these medications.”
Differences between the previous surveillance of obesity and prevalence of weight loss prescriptions included that women had higher prevalence of weight loss medications despite the higher prevalence of obesity among men in the military.
- Lorei NC, Stahlman SL, Oh GT, Wells NY. Weight loss medication prescription prevalence in the active component, 2018-2023. MSMR. 2024 Jan 20;31(1):9-13. PMID: 38359359; PMCID: PMC10914017.
