Key action items to advance the field of obesity medications, developed at the Duke Clinical Research Institute's "Anti-Obesity Pharmacotherapy: An Urgent Need for Guidance, Access, and Equity" think tank, were recently published in JACC: Advances.

In their report, Pishoy Gouda, MD, BCh, BAO, MSc, et al., lay out four action items to ensure equitable, streamlined research and access to obesity medications: 1) develop an obesity research roadmap, 2) evaluate the regulatory and payer framework, 3) standardize obesity metrics, and 4) ensure equitable access to obesity medications.

The authors note that an obesity research roadmap should include efforts to understand the lifelong epidemiology and pathophysiology of obesity as well as the role of obesity medication. They also acknowledge the need to establish an evidence-based approach to the definition of obesity and obesity outcomes to ensure a more precise characterization of the condition, investigate more personalized treatment options and improve clinical outcomes. Efforts to enhance education and health literacy for both patients and clinicians are also warranted.

As the field of obesity medications continues to evolve, the authors note that regular reevaluation of the regulatory and payer framework is necessary, particularly regarding "reimbursement standards in special populations, class indications for labeling, use of innovative clinical trial designs, novel endpoints in obesity trials, and the need for continued use of placebo-controlled trials."

Gouda and colleagues also describe the inequities in the prevalence of obesity and availability of treatments. They note that rates of obesity differ by race, ethnicity and geographic location, and that obesity clinical trials to date have largely failed to focus on the patient populations impacted the most.

Financial barriers to obesity medications are also considered. "The financial burden (including co-payments) may lead to a disproportionate increase in the use of unregulated compounded [obesity medications] among marginalized populations...associated with significant adverse effects," state the authors.