According to a study published in JAMA Network Open, the use of weight loss medication has increased in recent years by a staggering 132.6%. While the potential benefits of weight loss are undeniable, there is a growing concern surrounding the level of patient risk associated with the one-size-fits-all approach to the supply and how obesity is measured, specifically the Body Mass Index (BMI) scale and its implications for Black patients.
BMI has long been used as a standard measure to determine healthy weight ranges. It has long been hypothesised that Black patients have genetically greater skeletal muscle mass and bone density than white patients. However, with limited published research, training and understanding, and the increasing accessibility to weight loss medication, there is a growing concern that aesthetically and metabolically healthy individuals from these communities might be classified as ‘overweight’ or even ‘obese’ based on BMI alone.
The pharmaceutical industry’s clinical trials have historically underrepresented minority populations, leaving gaps in understanding potential side effects and long-term impacts. Clinical trials of medications such as Mounjaro and Ozempic published by the Food and Drug Administration (FDA) indicate a 4% and 6% representation of Black participants. The UK approval by the Medicines and Healthcare products Regulatory Agency (MHRA) based on the data provided by a post-approval clinical study published in the New England Journal of Medicine stated that, “The diversity of the trial population did not duplicate a globally representative population; specifical, women and patients identifying as Black were underrepresented.”
As weight loss jabs continue to make headlines and conversations about obesity become more prevalent, public health experts, clinicians and pharmacist must consider these nuances.
It is essential to move beyond this one-size-fits-all solutions and advocate for a more nuanced approach to health and weight management to ensure that interventions improve health outcomes equitably. Until then, individuals and healthcare providers must take an approach that truly serves the diverse needs of our communities and be challenged to consider alternative health metrics, such as body composition analysis and waist-to-hip ratio, to better evaluate individual health needs.
By Abundance Temile, clinical pharmacist
The PDA’s view
This article raises interesting points about the potential healthcare variation which patients from non-White groups can experience. In this case potentially ascribing BMI related risk levels across several different ethnicities which may not be equally relevant for all of those groups.
The PDA has long argued that provision of weight-loss medicines via online and remote routes is not appropriate and can result in patients receiving supplies when it is not in their best interest, particularly where supply has rested on the contents of an online questionnaire. The PDA would always advocate for a face-to-face professional clinical discussion between the patient and prescriber where all the important points related to motivations, past medical history, and risks and benefits of treatment can be covered before a joint decision is made on treatment.
The issue of utilising the waist-to-hip ratio rather than the BMI is food for thought for members, although complicated by the licensed dosage recommendations for weight-loss drugs which only utilise the BMI. However, members who are interested can find a waist-to-hip ratio calculator by clicking here and has guidance on whether results fall into low, medium or high risk for obesity-related problems. It may be that considering both measures could provide a more balanced view.
The PDA would encourage any members involved in the supply of weight-loss medications to ensure that an appropriate two-way conversation with the patient, access to relevant medical history, communication with the patient’s GP to advise them of what has been provided, and ongoing monitoring, exercise and dietary advice form a routine part of their consultations.
Get involved
- Join the PDA BAME Network
- Follow the PDA BAME Network on social media using #PDAbame
- If you would like to get involved with the network and its activities, email [email protected]
Learn more
- Metabolic Bariatric Surgery in the Era of GLP-1 Receptor Agonists for Obesity Management
- Measures of body composition in blacks and whites: a comparative review
- Drug Trials Snapshots: MOUNJARO
- Drug Trial Snapshot: Ozempic
- MHRA approves GLP –1 receptor agonist semaglutide to reduce risk of serious heart problems in obese or overweight adults
- Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes
- Waist to Hip Ratio Calculator
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