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Obesity and Eligibility for Obesity Treatments Among Adults With Disabilities in the U.S.

      Introduction

      Obesity has been associated with disability; yet, the proportion who meet clinical criteria for obesity treatment among adults with disabilities remains poorly defined. Characterization of obesity and treatment eligibility by disability type may prioritize high-need groups. This study assessed the prevalence of obesity and eligibility for antiobesity pharmacotherapy and/or bariatric surgery in adults with disability.

      Methods

      This cross-sectional weighted analysis of the 2019 National Health Interview Survey, including self-reported health and sociodemographic information, was conducted in 2021. Burden of obesity defined by BMI and odds of meeting consensus criteria for antiobesity pharmacotherapy and/or surgery were calculated by functional disability type: vision, hearing, cognition, communication, mobility, and self-care.

      Results

      From 29,170 community-dwelling adult respondents (59.1% response), the overall prevalence of disability was 10%. The prevalence of obesity among adults with a disability was 40.1% vs 30.5% for U.S. adults overall (p<0.0001). An estimated 17.1% with disability met the criteria for both bariatric surgery and antiobesity pharmacotherapy; another 39.8% were eligible for pharmacotherapy alone (vs 7.9% and 33.2%, respectively, for adults overall; p<0.0001). In fully adjusted models, disability was associated with greater ORs for mild obesity (OR=1.2; 95% CI=1.1, 1.4), moderate‒severe obesity (OR=2.1; 95% CI=1.8, 2.3), and criteria for bariatric surgery (OR=2.4; 95% CI=2.1, 2.7) and pharmacotherapy (OR=1.3; 95% CI=1.2, 1.4). Mobility, self-care, and cognition disabilities were associated with eligibility for bariatric surgery and antiobesity pharmacotherapy.

      Conclusions

      Individuals with disabilities have higher odds of obesity and eligibility for antiobesity treatments. Comorbidities should be considered, accommodations should be provided, and insurance coverage should be expanded to ensure access to antiobesity treatments for adults with disabilities.
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      REFERENCES

        • Froehlich-Grobe K
        • Lollar D
        Obesity and disability: time to act.
        Am J Prev Med. 2011; 41: 541-545https://doi.org/10.1016/j.amepre.2011.07.015
        • University of New Hampshire Institute on Disability
        2017 Disability statistics annual report.
        University of New Hampshire Institute on Disability, Durham, NH2021 (Published January 2018. Accessed September 15)
        • Hales CM
        • Fryar CD
        • Carroll MD
        • Freedman DS
        • Ogden CL
        Trends in obesity and severe obesity prevalence in U.S. youth and adults by sex and age, 2007-2008 to 2015-2016.
        JAMA. 2018; 319: 1723-1725https://doi.org/10.1001/jama.2018.3060
        • Weil E
        • Wachterman M
        • McCarthy EP
        • et al.
        Obesity among adults with disabling conditions.
        JAMA. 2002; 288: 1265-1268https://doi.org/10.1001/jama.288.10.1265
        • Froehlich-Grobe K
        • Lee J
        • Washburn RA
        Disparities in obesity and related conditions among Americans with disabilities.
        Am J Prev Med. 2013; 45: 83-90https://doi.org/10.1016/j.amepre.2013.02.021
        • Alley DE
        • Chang VW
        The changing relationship of obesity and disability, 1988‒2004.
        JAMA. 2007; 298: 2020-2027https://doi.org/10.1001/jama.298.17.2020
        • Chang VW
        • Alley DE
        • Dowd JB
        Trends in the relationship between obesity and disability, 1988-2012.
        Am J Epidemiol. 2017; 186: 688-695https://doi.org/10.1093/aje/kwx092
        • Hales CM
        • Carroll MD
        • Fryar CD
        • Ogden CL
        Prevalence of obesity and severe obesity among adults: United States, 2017-2018.
        NCHS Data Brief. 2020; : 1-8
      1. Y Xia, CM Kelton, JJ Guo, B Bian, and PC Heaton. Treatment of obesity: pharmacotherapy trends in the United States from 1999 to 2010. Obesity (Silver Spring). 2015;23(8):1721‒1728. https://doi.org/10.1002/oby.21136.

        • Gasoyan H
        • Tajeu G
        • Halpern MT
        • Sarwer DB
        Reasons for underutilization of bariatric surgery: the role of insurance benefit design.
        Surg Obes Relat Dis. 2019; 15: 146-151https://doi.org/10.1016/j.soard.2018.10.005
        • Jensen MD
        • Ryan DH
        • Apovian CM
        • et al.
        2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults.
        Circulation. 2014; 129 (suppl 2)): S102-S138https://doi.org/10.1161/01.cir.0000437739.71477.ee
        • English WJ
        • DeMaria EJ
        • Hutter MM
        • et al.
        American Society for Metabolic and Bariatric Surgery 2018 estimate of metabolic and bariatric procedures performed in the United States.
        Surg Obes Relat Dis. 2020; 16: 457-463https://doi.org/10.1016/j.soard.2019.12.022
        • Elangovan A
        • Shah R
        • Smith ZL
        Pharmacotherapy for obesity-trends using a population level national database.
        Obes Surg. 2021; 31: 1105-1112https://doi.org/10.1007/s11695-020-04987-2
        • National Center for Health Statistics
        Centers for Disease Control and Disease. National Health Interview Survey.
        National Center for Health Statistics, Centers for Disease Control and Disease, Atlanta, GA2019https://doi.org/10.15620/cdc:100685 (Published 2021)
      2. About the Washington Group. The Washington Group on Disability Statistics. https://www.washingtongroup-disability.com/. Updated January 1, 2021. Accessed September 25, 2021.

        • Colman E
        Food and Drug Administration’s Obesity Drug Guidance Document: a short history.
        Circulation. 2012; 125: 2156-2164https://doi.org/10.1161/CIRCULATIONAHA.111.028381
        • Consensus Development Conference Panel. NIH conference
        Gastrointestinal surgery for severe obesity. Consensus Development Conference Panel.
        Ann Intern Med. 1991; 115 (https://doi.org/10.7326/0003-4819-115-12-956): 956-961
        • Poirier P
        • Giles TD
        • Bray GA
        • et al.
        Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss: an update of the 1997 American Heart Association Scientific Statement on Obesity and Heart Disease from the Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism.
        Circulation. 2006; 113: 898-918https://doi.org/10.1161/CIRCULATIONAHA.106.171016
      3. Health risks of overweight & obesity. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). https://www.niddk.nih.gov/health-information/weight-management/adult-overweight-obesity/health-risks. Updated February 1, 2018. Accessed September 22, 2021.

      4. SAS® 9.4. Cary, NC: SAS Institute Inc.; 2013. www.sas.com. Accessed May 17, 2021.

        • Madans JH
        • Loeb ME
        • Altman BM
        Measuring disability and monitoring the un Convention on the Rights of Persons with Disabilities: the work of the Washington Group on Disability Statistics.
        BMC Public Health. 2011; 11 (suppl): S4https://doi.org/10.1186/1471-2458-11-S4-S4
        • Tsui ST
        • Yang J
        • Zhang X
        • et al.
        Health disparity in access to bariatric surgery.
        Surg Obes Relat Dis. 2021; 17: 249-255https://doi.org/10.1016/j.soard.2020.10.015
        • Iezzoni LI
        Dangers of diagnostic overshadowing.
        N Engl J Med. 2019; 380: 2092-2093https://doi.org/10.1056/NEJMp1903078
        • Rimmer JH
        • Riley B
        • Wang E
        • Rauworth A
        • Jurkowski J
        Physical activity participation among persons with disabilities: barriers and facilitators.
        Am J Prev Med. 2004; 26: 419-425https://doi.org/10.1016/j.amepre.2004.02.002
        • Humphries K
        • Traci MA
        • Seekins T
        Nutrition and adults with intellectual or developmental disabilities: systematic literature review results.
        Intellect Dev Disabil. 2009; 47: 163-185https://doi.org/10.1352/1934-9556-47.3.163
        • Holmgren M
        • Sandberg M
        • Ahlström G
        The complexity of reaching and maintaining a healthy body weight - the experience from adults with a mobility disability.
        BMC Obes. 2018; 5: 33https://doi.org/10.1186/s40608-018-0212-6
        • Moscoso-Porras MG
        • Alvarado GF
        Association between perceived discrimination and healthcare-seeking behavior in people with a disability.
        Disabil Health J. 2018; 11: 93-98https://doi.org/10.1016/j.dhjo.2017.04.002
        • Alberga AS
        • Edache IY
        • Forhan M
        • Russell-Mayhew S
        Weight bias and health care utilization: a scoping review.
        Prim Health Care Res Dev. 2019; 20: e116https://doi.org/10.1017/S1463423619000227
        • Gibbons E
        • Casey AF
        • Brewster KZ
        Bariatric surgery and intellectual disability: furthering evidence-based practice.
        Disabil Health J. 2017; 10: 3-10https://doi.org/10.1016/j.dhjo.2016.09.005
        • Gomez G
        • Stanford FC
        US health policy and prescription drug coverage of FDA-approved medications for the treatment of obesity.
        Int J Obes (Lond). 2018; 42: 495-500https://doi.org/10.1038/ijo.2017.287
      5. Treat and Reduce Obesity Act of 2021;S596:117th Cong, 1st sess (2021). https://www.congress.gov/bill/117th-congress/senate-bill/596/text. Accessed March 15, 2022.

      6. Medicare's criteria for weight loss surgery coverage. Obesity Coverage. https://www.obesitycoverage.com/am-i-covered/check-my-insurance/item/medicaid-s-criteria-for-weight-loss-surgery-coverage. Updated 2020. Accessed March 15, 2022.

        • Jannah N
        • Hild J
        • Gallagher C
        • Dietz W
        Coverage for obesity prevention and treatment services: analysis of Medicaid and state employee health insurance programs.
        Obesity (Silver Spring). 2018; 26: 1834-1840https://doi.org/10.1002/oby.22307
        • Erickson W
        • Lee C
        • von Schrader S
        2018 Disability status report.
        Cornell University Yang-Tan Institute on Employment and Disability, 2022 (Published 2020. Accessed March 14, 2022.)
        • Kennedy J
        • Blodgett E
        Health insurance-motivated disability enrollment and the ACA.
        N Engl J Med. 2012; 367: e16https://doi.org/10.1056/NEJMp1208212
        • Wildman RP
        • Gu D
        • Reynolds K
        • Duan X
        • He J
        Appropriate body mass index and waist circumference cutoffs for categorization of overweight and central adiposity among Chinese adults.
        Am J Clin Nutr. 2004; 80: 1129-1136https://doi.org/10.1093/ajcn/80.5.1129
      7. Disability and obesity. United States Centers for Disease Control and Prevention. https://www.cdc.gov/ncbddd/disabilityandhealth/obesity.html. Updated 2019. Accessed May 17, 2021.

      8. Frequently asked questions. The Washington Group on Disability Statistics. https://www.washingtongroup-disability.com/resources/frequently-asked-questions/. Updated 2021. Accessed March 14, 2022.