M. Jackson Foundation for the Advancement of Military Medicine and Walter Reed National Military Medical Center, all in Bethesda, MD, offered some explanations for why the trends differed so much. “Although TRICARE began covering obesity medications (OMs) in 2018, prior analyses demonstrated limited utilization,” they wrote. “With policy changes in September 2024 that streamlined access and the introduction of newer agents such as semaglutide (Wegovy) and tirzepatide (Zepbound), this study examined updated prescribing trends and predictors of OM use from fiscal years (FY) 2023-2024.” Their cross-sectional study analyzed demographic, clinical, and pharmacy claims data from the MHS Data Repository for adult TRICARE Prime and Plus beneficiaries ages 18-64, without Type 1 or Type 2 diabetes and with a body mass index (BMI) of 27 or higher. Defined as the primary outcome was receipt of one or more TRICARE-approved OMs, excluding formulations approved for diabetes. Predictors of OM use were calculated by sex, age, race/ethnicity, beneficiary category, rank, comorbidity status (prediabetes, metabolic syndrome, coronary artery disease, obstructive sleep apnea) and care setting. Results indicated that, among 568,232 BMI-eligible adult beneficiaries, 31,176 (5.5%) received at least one OM. Users of obesity medications were found to be predominantly female (81%), ages 30-59 years and dependents (71%). Half of those had a primary-care manager in direct care and half in the private sector. The most prescribed agents included: • phentermine (41%), • semaglutide (Wegovy, 28%), • naltrexone/bupropion (20%), • phentermine/topiramate (16%) and • tirzepatide (Zepbound, 15%). The data underscored that, as obesity remains a sig- nificant health threat, first-generation weight-loss med- ications continue to play an important role in clinical practice. (See accompanying article, pg. xx.) “Female sex (OR = 4.07) and senior enlisted rank (OR = 1.13) were associated with significantly (P < .05) higher odds of use; Asian/Pacific Islander (OR = 0.59), Hispanic (OR = 0.81), Black (OR = 0.82), and active- duty (OR = 0.64) beneficiaries had significantly (P < .05) lower odds,” the researchers advised. The authors cautioned, “Recent TRICARE coverage changes may further shape access and prescribing patterns, though their downstream effects on health outcomes, readiness, and costs remain uncertain.” They said their findings “highlight ongoing knowledge gaps regarding the optimal, sustainable use of OM in the MHS and underscore the need for MHS- specific effectiveness, safety, and cost-effectiveness data to inform evidence-based, readiness-aligned obesity care strategies.” The military continues to be under pressure about ris- ing obesity rates within the U.S. armed forces. Earlier this year, a coalition of national organizations, including the American Security Project and Obesity Care Advocacy Network, sent a letter to DoD Secretary Pete Hegseth urg- ing action on rising obesity rates within the U.S. armed forces. The letter warned that obesity is an “urgent threat” to military readiness, calling for improved nutritional access and fitness opportunities, among other measures. More than 70 national security, military and public health stakeholders signed the letter to the Pentagon, which called for stronger, evidence-based obesity prevention and treatment programs to maintain a ready force. The letter argued that addressing obesity is essential for national security and the long-term health of American forces. Earlier this year, a study was published in MSMR about the prevalence of obesity among active-component servicemembers. The researchers used height and weight data from the MHS Data Repository for ACSMs (cumulative n=12,262,745) and the National Health and Nutrition Examination Survey for civilians ages 17-62 years (cumulative n=19,334). Results indicated that, from 2013 through 2023, obesity prevalence increased among ACSMs, from 14.7% to 24.2%. “Although obesity rates among civilians were consistently higher, this gap narrowed over the course of the decade,” wrote the researchers from the national Centers for Disease Control and Prevention in Atlanta and the Armed Forces Health Surveillance Division, Public Health Directorate, Defense Health Agency, in Silver Spring, MD. “The same pattern was seen in young men (ages 17-24 years). Civilians have greater proportions within the highest classes of BMI than ACSMs. Persistently high obesity prevalence among ACSMs overall and in young men, particularly since 2019, may affect military recruitment, retention, and ultimately, strength and readiness.” The study advised that the “persistently high preva- lence of obesity among civilians and growing prevalence of obesity among active component service members in general, and among young men in particular, may affect military recruitment, retention, and ultimately, 2 0 2 6 C O M P E N D I U M O F F E D E R A L M E D I C I N E 8 7
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