Strategies to break down barriers at different stages of treatment

Abstract

Advances in understanding the biology of obesity and the development of more effective drugs for weight loss and the improvement or remission of associated conditions have revolutionized its approach and treatment. However, for a given treatment to achieve the expected effectiveness, it must be prescribed or administered in a timely manner, and the patient must use it for the necessary length of time and at the indicated dose to achieve the therapeutic objectives.

Drug treatment persistence is defined as the time during which a patient continues treatment or continues renewing/refilling the prescription, from the start of treatment until its discontinuation. In a retrospective cohort study of 1,911 patients, adherence to available obesity medications was evaluated between 2015 and 2023. This included GLP-1RAs and naltrexone-bupropion, among others not available in our country. It was found that 44% of individuals were persistent at 3 months, 33% at 6 months, and 19% at 12 months. This reflects a real-life problem of poor adherence to pharmacological treatment.

According to the WHO, adherence is the degree to which a person's behavior, whether taking medication, following a diet plan, or implementing lifestyle changes, corresponds to the recommendations agreed upon by a healthcare professional. Non-adherence is usually defined as taking less than 80% of the prescribed dose of the medication. Adherence is related to factors specific to the patient, the chronic disease, the treatment, the provider and the healthcare system, and, finally, social and economic factors. Barriers to adherence vary across different stages, making it necessary to analyze potential intervention strategies for the initiation, implementation, and persistence of medications for the treatment of obesity. This also applies to periods of weight gain, loss, stabilization, or regain.

Considering the stage of treatment in relation to adherence and the phase of the disease can help identify possible reasons for low adherence.