Weight loss experiences and willingness to intervention with pharmacotherapy among obese and very obese Danish people.

OBJECTIVES: Obesity is a growing issue with increasing impact on healthcare budgets, yet very little is known about weight loss experiences of people with body mass index (BMI)≥30kg/m(2) and their willingness to try and pay for weight loss interventions (WLI). The objective of this survey was to gather knowledge about weight loss experiences among obese and severely obese people. METHODS: 1,003 Danish people >18 years of age with BMI≥30 who wanted to lose weight completed an online survey. Data included demographics, experience with WLI, awareness of anti-obesity medication (AOM), and willingness to try and pay for WLI including AOM. RESULTS: Respondents had been trying to lose weight for several years (medium [25% percentile;75% percentile]);5.1[2.0;10.3] years (BMI 30-35) and 10.0 [5.0;20.0] (very obese (BMI>35) with co-morbidities (OWC). The desired weight loss was 20.0 [15.0;25.0] kg (BMI 30-35) and 35.0 [28.0;47.5] kg (OWC). Independent of educational level and gender, health concern was the main incentive for weight loss. Several WLI had been tried repeatedly, yet 60% of respondents with BMI 30-35 and 50% of the OWC were unaware of AOM. Among those who had tried AOM, side effects and lack of effectiveness were the main reasons to stop. 50-73% were willing to try AOM dependent on expected weight loss. Willingness to try and pay for new AOM was strongest for the OWC. CONCLUSION: Respondents had made repeated attempts for up to a decade to lose weight, yet remained far from their ideal weight. They had spent a substantial amount of money on WLI, had limited information of AOM, and indicated a desire for increased professional support.

Evaluating the Long-Term Health Economic Implications of Improving the Proportion of Patients with Type 2 Diabetes Meeting Treatment Targets in Mexico.

OBJECTIVES: To analyze the health economic implications of increasing the proportion of patients with type 2 diabetes meeting treatment targets for glycemia, blood pressure, and serum lipid levels in Mexico. METHODS: Complication rates, life expectancy, quality-adjusted life expectancy, and costs were projected over patient lifetimes using a published and validated diabetes model (with outcomes discounted at 5% annually). Baseline cohort characteristics were derived from the Mexican cohort of A1chieve. Scenarios in which 20% to 80% of the patients achieved glycemic targets (glycosylated hemoglobin [HbA1c] level of 7%) only, or blood pressure and lipid targets (based on international guidelines) in addition to glycemic targets were compared with current standard of care. RESULTS: Increasing the proportion of patients meeting Hb A1c targets was projected to increase mean life expectancy and quality-adjusted life expectancy by up to 0.60 years and 0.34 quality-adjusted life-years over current care. When patients achieved all treatment targets, clinical benefits were greater than when only the Hb A1c level was controlled. Increasing the proportion of patients reaching the glycemic target was projected to lead to cost savings over conventional treatment, reducing mean costs by up to Mexican pesos 42,389 (US $3314). Surprisingly, bringing patients to other targets, as well as the Hb A1c target, did not result in greater cost savings. This was as a result of the increased life expectancy in these simulations, leading to greater costs in the final years (survival paradox). CONCLUSIONS: Increasing the proportion of patients achieving treatment targets resulted in improved clinical outcomes and cost savings from a health care payer perspective in Mexico.