Why do people with obesity, but without diabetes, start taking semaglutide?

By Dr. Priyom Bose, Ph.D.Reviewed by Danielle Ellis, B.Sc.Jan 22 2025

Factors such as sex, type of insurance plan, and the use of common medications influenced whether individuals with obesity but without diabetes initiated semaglutide treatment

A recent JAMA Network Open study investigated the factors associated with semaglutide initiation among obese adults without diabetes and with commercial insurance.

An increased demand for semaglutide

The demand for novel GLP-1 receptor agonist medications, such as tirzepatide (Zepbound, Mounjaro) and semaglutide (Wegovy, Ozempic), has surged. Initially prescribed for type 2 diabetes (T2D), these drugs are now FDA-approved for weight management and cardiovascular disease prevention.

Obesity, often overlooked as a treatable disease, is a significant risk factor for diabetes and cardiometabolic conditions. Despite the availability of effective treatments like GLP-1 receptor agonists, many obese individuals remain undertreated, with lifestyle counseling being the primary recommendation.

In the U.S., where 73.6% of the population is overweight or obese, a notable number of individuals use GLP-1 agonists for weight management without physician guidance.

However, access to these medications is often limited by insurance coverage disparities, disproportionately affecting people from low socioeconomic backgrounds and Black and Hispanic communities. Addressing these inequities is crucial to reducing the obesity burden.

About the study

The current study sought to explore the factors that control semaglutide initiation among obese adults without diabetes and having commercial insurance. A machine learning approach was used to identify factors, and a multivariable regression modeling strategy helped quantify the association of the leading factors with semaglutide initiation.

All relevant data were obtained from the Merative MarketScan Commercial Claims and Encounters database (formerly IBM Marketscan) from the period between June 5, 2020, and December 31, 2022. MarketScan is a commercial health insurance provider whose databases offer demographic information, inpatient and outpatient claims, and medicines prescribed to insured customers aged between 18 and 64 years.

A cohort was created, including individuals with at least one encounter with a healthcare professional for obesity in an inpatient or outpatient capacity. The first claim detected from the database was used as the baseline data for obesity diagnosis. Individuals with bariatric surgery, those prescribed an antihyperglycemic medication, and individuals pregnant six months before obesity diagnosis were excluded.

Study findings

A total of 97,456 individuals between 45 and 54 years of age met the inclusion criteria, among which 50.7% of the cohort was covered by preferred provider organization (PPO) plans. More than 50% of the cohort resided in the South region.

Approximately 2% of the selected participants were prescribed semaglutide within 6 months of their initial obesity diagnosis. Individuals between 55 and 64 years of age were more frequently prescribed semaglutide than those who were between 18 and 24 years of age.

Individuals with the highest body mass index were the largest group to receive semaglutide prescriptions. An AUROC model identified sex, economic condition, age, region, employee status, and insurance plan type to be the top factors that were associated with semaglutide initiation.

In comparison to men, females and older individuals from the Northeast and South who were employed in the service industry and had PPO plans were more likely to receive semaglutide prescriptions. Individuals with unknown employer industries were less likely to have semaglutide initiation.

Multivariable logistic regression analysis revealed that individuals with more recent index dates had higher odds of initiating semaglutide within 6 months, which peaked in March 2022 and declined through June 2022. Furthermore, individuals from the North Central and Northeast regions were more likely to initiate semaglutide compared with those residing in the West.

Individuals with employers in non-durable goods manufacturing, insurance, real estate, and finance were more likely to start semaglutide. Participants with a prescription of amphetamine stimulant and antidepressant medications were at higher odds of receiving semaglutide.

Conclusions

This study used a novel machine learning approach to identify health care, sociodemographic, and clinical factors associated with semaglutide initiation within 6 months of obesity diagnosis.

The studied group showed the presence of inequities in medication access. More research could be conducted to understand whether simultaneous use of common medications impacts effectiveness and using a sample comprising those with public payer plans.