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Cited by 24Pharmacology and Obesity TreatmentBariatric Surgery and OutcomesDiabetes Treatment and Management

Regional trends and disparities in newer GLP1 receptor agonist initiation among real‐world adult patients eligible for obesity treatment

Open access
Radwan, Rotana M., Lee, Yao An, Kotecha, Pareeta, Wright, Davene R., Hernandez, Inmaculada, Ramon, Ronald, Donahoo, William T., Chen, Yong +3 more·2025·Diabetes Obesity and Metabolism
DOI 10.1111/dom.16318PMC PMC12049259
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Abstract

AIMS: To characterize trends in the initiation of newer anti-obesity medications (AOMs) and determine factors associated with their use among obese/overweight populations. MATERIALS AND METHODS: with at least one obesity-related comorbidity. The primary outcome was the initiation of newer AOMs, specifically glucagon-like peptide-1 receptor agonists (GLP-1 RAs) including liraglutide, semaglutide and tirzepatide. Trends across years were examined, and a multivariable logistic regression identified sociodemographic, clinical and healthcare utilization factors associated with AOM initiation. RESULTS: Of 319,949 adults, 1.8% initiated newer AOMs. Semaglutide accounted for 77.9% of initiations, tirzepatide 19.7% and liraglutide 17.8%. Initiation trends showed liraglutide uptake peaked at 5% in 2018 but declined afterward, while semaglutide and tirzepatide uptake increased exponentially since 2022. Odds of initiation were lower for Black (aOR [95% CI]: 0.87 [0.80-0.94]) and Hispanic (0.84 [0.78-0.91]) groups versus Whites, and for Medicaid (0.69 [0.63-0.76]) and uninsured (0.81 [0.74-0.87]) patients versus privately insured. Higher odds were associated with being female, middle-aged, having more outpatient visits and visiting endocrinologists. CONCLUSIONS: The initiation of newer AOMs among overweight and obese populations remains low, but uptake has increased exponentially since 2022. Our findings reveal significant disparities in obesity care, highlighting the importance of addressing inequities in AOM access to improve obesity outcomes.

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Crossref · 10.1111/dom.16318

Cites

31 of 31 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 32 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Opioid use was associated with lower odds of initiating newer AOMs (aOR 0.83, 95% CI 0.77-0.89).

    “opioid users (0.83, [0.77, 0.89])”
    Quote in the paperNot a substantial claim
  • Findingown data

    Among newer anti-obesity medication initiators, 19.1% were non-Hispanic White.

    “Most individuals initiating newer AOMs were obese (74.9%), female (70.6%), non-Hispanic White (19.1%), aged 40–65 years (60.1%), and privately insured (61.2%).”
    Quote in the paperNot a substantial claim
  • Findingown data

    Tirzepatide initiation grew from 6.5% in 2022 to 25.2% in 2023.

    “Tirzepatide, introduced in 2022, rapidly grew from 6.5% in its first year to 25.2% in 2023.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Consulting a specialized nurse practitioner/physician assistant was associated with higher odds of initiating newer AOMs compared with primary care (aOR 1.60, 95% CI 1.50-1.71).

    “specialized nurse practitioner/physician assistant (1.60, [1.50, 1.71])”
    Quote in the paperSubstantial claim
  • Findingown data

    Heart failure was associated with lower odds of initiating newer AOMs (aOR 0.55, 95% CI 0.39-0.77).

    “heart failure (0.55, [0.39, 0.77])”
    Quote in the paperNot a substantial claim
  • May combine two claims. 32
  • Classified as probably not a substantial claim. 12

  • May combine two claims.

    Findingown data

    Among non-diabetic individuals, higher odds of newer AOM initiation were seen in females, those aged 40-65 years, and antidepressant users.

    “Among non-diabetic individuals, higher odds were seen in females, those aged 40–65 years, and antidepressant users.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Newer AOM uptake was higher in Central, North, and Southeast Florida and lower in Southwest, Northwest, and Panhandle regions.

    “Overall, higher AOM uptake was seen in Central, North, and Southeast Florida, with lower uptake in the Southwest, Northwest, and Panhandle.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Among non-diabetic individuals, lower odds of newer AOM initiation were associated with former smoking, heart failure, coronary artery disease, arthritis, opioid use, minority racial or ethnic groups, and public or no insurance.

    “Lower odds were associated with former smoking, heart failure, coronary artery disease, arthritis, opioid use, minority racial or ethnic groups, and public or no insurance (Table S2).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Among diabetic individuals, lower odds of newer AOM initiation were observed for age ≥65, Medicaid insurance, heart failure, and current smoking.

    “For diabetic individuals, lower odds were observed among those aged 65 or older, Medicaid insurance, heart failure, and current smoking, (Table S3).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In 2023 versus prior years, lower odds of newer AOM initiation were associated with minority populations, public or no insurance, age ≥65, opioid users, current smokers, Charlson Comorbidity Index score of 1, and ≥1 hospitalizations or emergency room visits.

    “Lower odds were observed among minority populations, those with public or no insurance, individuals aged 65 or older, opioid users, current smokers, those with a Charlson Comorbidity Index score of 1, and those with ≥1 hospitalizations or emergency room visits (Tables S4 and S5).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Liraglutide uptake was higher in scattered Central and Southeast counties and lower in the Panhandle and North Florida.

    “Liraglutide showed higher uptake in scattered Central and Southeast counties, with lower uptake in the Panhandle and North Florida.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In 2023 versus prior years, higher odds of newer AOM initiation were associated with obesity, female sex, middle age, metformin, antihypertensives, antidepressants, endocrinologist or specialized NP/PA visits, and ≥1 outpatient visits.

    “Odds were higher among those with obesity, females, middle age, users of metformin, antihypertensives, or antidepressants, those who visited an endocrinologist or specialized nurse/physician assistant, and ≥1 outpatient visits.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Liraglutide initiation began at 1.5% in 2015, peaked at 5.1% in 2018, and fell to 3.8% by 2023.

    “Liraglutide initiation remained relatively stable, starting at 1.5% in 2015, peaking at 5.1% in 2018, and gradually declining to 3.8% by 2023.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Among newer anti-obesity medication initiations, semaglutide accounted for 77.9%, tirzepatide 19.7%, and liraglutide 17.8%.

    “Semaglutide accounted for the highest proportion of newer AOM initiations (77.9%), followed by tirzepatide (19.7%) and liraglutide (17.8%).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In 2023, additional factors associated with lower odds of newer AOM initiation included anxiety, use of other glucose-lowering medications, coronary artery disease, and former smoking.

    “In 2023, additional factors associated with lower odds included anxiety, the use of other glucose-lowering medications, coronary artery disease, and former smoking (Table S5).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In both diabetes and non-diabetes subgroups, lower odds of newer AOM initiation were noted for age ≥65, current smoking, and hospitalizations or emergency room visits.

    “Lower odds were noted among individuals aged 65 or older, current smokers, and those with hospitalizations or emergency room visits (Tables S2 and S3).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Tirzepatide uptake was higher in select Central and Southeast counties and lower in the Panhandle and Southwest.

    “Tirzepatide uptake was higher in select Central and Southeast counties and lower in the Panhandle and Southwest.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In both diabetes and non-diabetes subgroups, higher odds of newer AOM initiation were observed for obesity, anxiety, antihypertensive or metformin use, endocrinologist or specialized NP/PA visits, and ≥1 outpatient visits.

    “In individuals with and without T2D, higher odds of initiating newer AOMs were observed among those with obesity, anxiety, antihypertensive or metformin use, visits to an endocrinologist or specialized nurse/physician assistant, and ≥1 outpatient visits.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Endocrinologists had the highest prevalence of prescribing newer AOMs.

    “endocrinologists had the highest prevalence of prescribing newer AOMs”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [25] Thomas CE, Mauer EA, Shukla AP, Rathi S, Aronne LJ. Low adoption of weight loss medications: A comparison of prescribing patterns of antiobesity pharmacotherapies and SGLT2s. Obesity (Silver Spring) 2016; 24: 1955– 1961 27569120 PMC5669035 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Among those who filled AOM prescriptions, 39% received naltrexone/bupropion, 29% phentermine-topiramate, 19% semaglutide, 11% liraglutide, and 1.2% orlistat.

    “Among those who filled prescriptions, 39% received naltrexone/bupropion, 29% phentermine-topiramate, 19% semaglutide, 11% liraglutide, and 1.2% orlistat (11).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [11] Gasoyan H, Pfoh ER, Schulte R, Sullivan E, Le P, Rothberg MB. Association of patient characteristics and insurance type with anti-obesity medications prescribing and fills. Diabetes Obes Metab 2024; 26: 1687– 1696 38287140 PMC11001528 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Projections from 2003 and 2014 indicate the endocrinology workforce is too small to meet current and future demand and significantly affect the obesity epidemic.

    “projections from 2003 and 2014 reveal that the endocrinology workforce is insufficient to meet current and future demand to significantly impact the obesity epidemic (26).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [26] Vigersky RA, Fish L, Hogan P, Stewart A, Kutler S, Ladenson PW, McDermott M, Hupart KH. The clinical endocrinology workforce: current status and future projections of supply and demand. J Clin Endocrinol Metab 2014; 99: 3112– 3121 24940655 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In 2024, the Biden-Harris Administration proposed expanding Medicare and Medicaid coverage for AOMs.

    “in 2024, the Biden-Harris Administration proposed expanding Medicare and Medicaid coverage for AOMs”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [24] House TW. FACT SHEET: Biden-Harris Administration Takes Latest Step to Lower Prescription Drug Costs by Proposing Expanded Coverage of Anti-Obesity Medications for Americans with Medicare and Medicaid. 2024

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Older anti-obesity drugs such as orlistat, phentermine/topiramate, bupropion/naltrexone, and lorcaserin yielded average weight loss of 10% or less after one year but carried serious safety risks.

    “have demonstrated an average body weight loss of ≤10% after one year, but with serious safety concerns such as cardiotoxicity, neuropsychiatric disorders, and cancer (6).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [6] Onakpoya IJ, Heneghan CJ, Aronson JK. Post-marketing withdrawal of anti-obesity medicinal products because of adverse drug reactions: a systematic review. BMC Med 2016; 14: 191 27894343 PMC5126837 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Racial and weight-related biases are documented to affect healthcare interactions.

    “Both racial and weight-related biases are documented to influence healthcare interactions (18–20).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [18] Ryan L, Coyne R, Heary C, Birney S, Crotty M, Dunne R, Conlan O, Walsh JC. Weight stigma experienced by patients with obesity in healthcare settings: A qualitative evidence synthesis. Obes Rev 2023; 24: e13606 37533183 source

      Not checked in the free run.

    • cites [19] Sarwer DB, Gasoyan H, Bauerle Bass S, Spitzer JC, Soans R, Rubin DJ. Role of weight bias and patient-physician communication in the underutilization of bariatric surgery. Surg Obes Relat Dis 2021; 17: 1926– 1932 34429250 PMC8551024 source

      Not checked in the free run.

    • cites [20] Blair IV, Steiner JF, Fairclough DL, Hanratty R, Price DW, Hirsh HK, Wright LA, Bronsert M, Karimkhani E, Magid DJ, Havranek EP. Clinicians’ implicit ethnic/racial bias and perceptions of care among Black and Latino patients. Ann Fam Med 2013; 11: 43– 52 23319505 PMC3596038 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    Patients with type 2 diabetes and those using glucose-lowering drugs are more likely to start newer AOMs, whereas those with coronary artery disease, heart failure, arthritis, or higher comorbidity burdens are less likely.

    “individuals with T2D and those on glucose-lowering are more likely to initiate newer AOMs, while those with coronary artery disease, heart failure, arthritis, or higher comorbidity burdens are less likely”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    Uninsured patients and those with public insurance are less likely to use newer AOMs than privately insured patients.

    “uninsured people or public insurance enrollees were less likely to use a newer AOM compared to private insurance enrollees”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    This proposed expansion is estimated to cut Medicare enrollees' out-of-pocket costs by up to 95% and benefit 4 million Medicaid enrollees.

    “This expansion is estimated to reduce Medicare enrollees’ out-of-pocket costs by up to 95% and benefit 4 million Medicaid enrollees (24).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [24] House TW. FACT SHEET: Biden-Harris Administration Takes Latest Step to Lower Prescription Drug Costs by Proposing Expanded Coverage of Anti-Obesity Medications for Americans with Medicare and Medicaid. 2024

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Tirzepatide achieved up to 22% mean weight loss after 72 weeks and improved cardiometabolic risk factors such as blood pressure, insulin, and lipids.

    “tirzepatide, showed up to 22% mean weight loss after 72 weeks, along with improved cardiometabolic risk factors”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [10] Jastreboff AM, Aronne LJ, Ahmad NN, Wharton S, Connery L, Alves B, Kiyosue A, Zhang S, Liu B, Bunck MC, Stefanski A, Investigators S-. Tirzepatide Once Weekly for the Treatment of Obesity. N Engl J Med 2022; 387: 205– 216 35658024 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Geographic accessibility to endocrinologists varies substantially across US counties and states, and access within a reasonable driving distance differs by urban/rural status and age.

    “There is also substantial US nationwide variations in geographic accessibility to endocrinologists at both county and state levels, as well as disparities in access to an endocrinologist within a reasonable driving distance, by urban/rural status and by age (27).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [27] Lu H, Holt JB, Cheng YJ, Zhang X, Onufrak S, Croft JB. Population-based geographic access to endocrinologists in the United States, 2012. BMC Health Serv Res 2015; 15: 541 26644021 PMC4672571 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Semaglutide achieved up to 15% mean weight loss that was maintained for at least two years.

    “semaglutide demonstrated up to 15% mean weight loss (8), sustained over at least two years (9)”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [8] Wilding JPH, Batterham RL, Calanna S, Davies M, Van Gaal LF, Lingvay I, McGowan BM, Rosenstock J, Tran MTD, Wadden TA, Wharton S, Yokote K, Zeuthen N, Kushner RF, Group SS. Once-Weekly Semaglutide in Adults with Overweight or Obesity. N Engl J Med 2021; 384: 989– 1002 33567185 source

      Not checked in the free run.

    • cites [9] Garvey WT, Batterham RL, Bhatta M, Buscemi S, Christensen LN, Frias JP, Jodar E, Kandler K, Rigas G, Wadden TA, Wharton S, Group SS. Two-year effects of semaglutide in adults with overweight or obesity: the STEP 5 trial. Nat Med 2022; 28: 2083– 2091 36216945 PMC9556320 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    Only 2% of patients started AOMs, which is lower than the 8% reported by Gasoyan et al.

    “only 2% of patients initiated AOMs, despite the exponential growth of newer AOM use. This is lower than the 8% reported in Gasoyan’s study”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [11] Gasoyan H, Pfoh ER, Schulte R, Sullivan E, Le P, Rothberg MB. Association of patient characteristics and insurance type with anti-obesity medications prescribing and fills. Diabetes Obes Metab 2024; 26: 1687– 1696 38287140 PMC11001528 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    These biases can affect patient-provider communication and willingness to seek obesity treatment, potentially leading to underuse of effective treatments like newer AOMs.

    “These biases can impact how patients communicate with healthcare providers and their willingness to seek treatment for obesity, potentially leading to underutilization of effective treatments like newer AOM (18–20).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [18] Ryan L, Coyne R, Heary C, Birney S, Crotty M, Dunne R, Conlan O, Walsh JC. Weight stigma experienced by patients with obesity in healthcare settings: A qualitative evidence synthesis. Obes Rev 2023; 24: e13606 37533183 source

      Not checked in the free run.

    • cites [19] Sarwer DB, Gasoyan H, Bauerle Bass S, Spitzer JC, Soans R, Rubin DJ. Role of weight bias and patient-physician communication in the underutilization of bariatric surgery. Surg Obes Relat Dis 2021; 17: 1926– 1932 34429250 PMC8551024 source

      Not checked in the free run.

    • cites [20] Blair IV, Steiner JF, Fairclough DL, Hanratty R, Price DW, Hirsh HK, Wright LA, Bronsert M, Karimkhani E, Magid DJ, Havranek EP. Clinicians’ implicit ethnic/racial bias and perceptions of care among Black and Latino patients. Ann Fam Med 2013; 11: 43– 52 23319505 PMC3596038 source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Newer GLP-1 receptor agonists including liraglutide, semaglutide, and tirzepatide have demonstrated better effectiveness, health benefits, and safety.

    “have shown greater effectiveness, health benefits, and safety profiles (7; 8).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [7] Jastreboff AM, Kushner RF. New Frontiers in Obesity Treatment: GLP-1 and Nascent Nutrient-Stimulated Hormone-Based Therapeutics. Annu Rev Med 2023; 74: 125– 139 36706749 source

      Not checked in the free run.

    • cites [8] Wilding JPH, Batterham RL, Calanna S, Davies M, Van Gaal LF, Lingvay I, McGowan BM, Rosenstock J, Tran MTD, Wadden TA, Wharton S, Yokote K, Zeuthen N, Kushner RF, Group SS. Once-Weekly Semaglutide in Adults with Overweight or Obesity. N Engl J Med 2021; 384: 989– 1002 33567185 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Private insurance coverage for AOMs varies by carrier and often requires strict preauthorization.

    “Among those with private insurance, coverage for AOMs varies by carrier and often involves strict preauthorization (23).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [23] Gasoyan H, Sarwer DB. Addressing insurance-related barriers to novel antiobesity medications: Lessons to be learned from bariatric surgery. Obesity (Silver Spring) 2022; 30: 2338– 2339 36190393 PMC9691525 source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Clinical guidelines permit pharmacotherapy alongside lifestyle interventions for adults with BMI at least 30 kg/m2 or BMI 27-29.9 kg/m2 plus at least one obesity-related comorbidity.

    “individuals with a body mass index (BMI) ≥30 kg/m2 or BMI ≥27 kg/m2 with at least one obesity-associated comorbidity can be offered pharmacotherapy in addition to lifestyle interventions”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [4] Jensen MD, Ryan DH, Apovian CM, Ard JD, Comuzzie AG, Donato KA, Hu FB, Hubbard VS, Jakicic JM, Kushner RF, Loria CM, Millen BE, Nonas CA, Pi-Sunyer FX, Stevens J, Stevens VJ, Wadden TA, Wolfe BM, Yanovski SZ, Jordan HS, Kendall KA, Lux LJ, Mentor-Marcel R, Morgan LC, Trisolini MG, Wnek J, Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Curtis LH, DeMets D, Hochman JS, Kovacs RJ, Ohman EM, Pressler SJ, Sellke FW, Shen WK, Smith SC Jr., Tomaselli GF, American College of Cardiology/American Heart Association Task Force on Practice G, Obesity S. 2013 AHA/ACC/TOS guideline for the manag source

      Not checked in the free run.

    • cites [5] Garvey WT, Mechanick JI, Brett EM, Garber AJ, Hurley DL, Jastreboff AM, Nadolsky K, Pessah-Pollack R, Plodkowski R, Reviewers of the AACEOCPG. American Association of Clinical Endocrinologists and American College of Endocrinology Comprehensive Clinical Practice Guidelines for Medical Care of Patients with Obesity. Endocr Pract 2016; 22 Suppl 3: 1– 203 27219496 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    Causality cannot be confirmed due to the inherent limitations of observational studies.

    “we cannot confirm causality due to the inherent limitations of observational studies.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Patient tolerance to AOMs and adverse event experiences affect adherence, but these were outside the study's scope.

    “factors such as patients’ tolerance to AOMs and experiences with adverse events influence treatment adherence, but these aspects were beyond the scope of this study.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Lower initiation rates among racial and ethnic minorities, uninsured patients, and those with limited healthcare access point to systemic barriers in obesity treatment.

    “We identified lower initiation rates among racial and ethnic minorities, the uninsured, and those with limited healthcare access, revealing systemic barriers to obesity treatment.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Direct comparison with prior studies was difficult because they mainly included traditional AOMs; when newer AOMs were included, they usually involved semaglutide, liraglutide, or both, but none included tirzepatide.

    “it was difficult to directly compare our findings with previous studies, which primarily included traditional AOMs. When newer AOMs were included, they typically involved semaglutide, liraglutide, or both, but none included tirzepatide.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning

    ADI served as a proxy for socioeconomic status but may not fully capture individual-level socioeconomic differences, potentially causing residual confounding.

    “the ADI was used as a close proxy, but because it is multifaceted, it may not fully capture the individual-level socioeconomic differences that could impact health behaviors and access to care, potentially leading to residual confounding in our analysis.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    From 2015 to 2023, only 8.0% of adults received AOM prescriptions and 4.4% filled them.

    “Between 2015 to 2023, only 8.0% of adults had AOM prescriptions, and just 4.4% filled their prescriptions.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [11] Gasoyan H, Pfoh ER, Schulte R, Sullivan E, Le P, Rothberg MB. Association of patient characteristics and insurance type with anti-obesity medications prescribing and fills. Diabetes Obes Metab 2024; 26: 1687– 1696 38287140 PMC11001528 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Most state Medicaid programs and Medicare Part D plans do not cover AOMs for obesity, including Florida.

    “most state Medicaid programs and Medicare Part D plans do not cover AOMs, including Florida (21; 22).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [21] Hernandez I, Wright DR, Guo J, Shrank WH. Medicare Part D Coverage of Anti-obesity Medications: a Call for Forward-Looking Policy Reform. J Gen Intern Med 2024; 39: 306– 308 37715099 PMC10853087 source

      Not checked in the free run.

    • cites [22] Alliance SO. Medicaid Obesity Treatment Coverage 2024. 2024

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Privately insured patients were more likely to receive and fill AOM prescriptions.

    “individuals with private insurance were more likely to receive both AOM prescriptions and have them filled (11).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [11] Gasoyan H, Pfoh ER, Schulte R, Sullivan E, Le P, Rothberg MB. Association of patient characteristics and insurance type with anti-obesity medications prescribing and fills. Diabetes Obes Metab 2024; 26: 1687– 1696 38287140 PMC11001528 source

      Not checked in the free run.

38 of 38

  • The paper relies on this without support.

    Before this study, limited data existed on initiation of newer AOMs such as liraglutide, semaglutide, and tirzepatide.

    “Limited data exists on the initiation of newer AOMs (e.g., liraglutide, semaglutide, and tirzepatide).”

  • The paper relies on this without support.

    Insurance coverage for GLP-1 receptor agonists to treat type 2 diabetes is better than coverage for obesity.

    “In contrast, access to GLP-1 RAs to treat T2D has better coverage.”
2 of 2

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • A critical dichotomy has emerged between the highly supervised environment of RCTs and the realities of routine clinical practice.

    “However, a critical dichotomy has emerged between the highly supervised environment of RCTs and the realities of routine clinical practice [4,5,16,17,18].”

    From Adherence and Persistence with GLP-1-Based Therapies: International Real-World Evidence and the Role of Nutritional and Lifestyle Support—A Narrative Review (2026) · cites this paper as [18]

    The Background reports substantial weight loss with newer anti-obesity medications, while the Discussion reports that only 2% of eligible patients initiated anti-obesity medications in this real-world cohort. This supports a contrast between reported treatment benefits and routine uptake, but the paper does not describe RCTs as highly supervised or directly compare their environment with clinical practice. The indexed passages provide no page numbers. (LLM, conf=0.77)

    Experimental — accuracy not yet measured

  • Real-world effectiveness of GLP-1 RAs lags trial efficacy, largely owing to high discontinuation rates.

    “However, real-world effectiveness lags trial efficacy, largely owing to high discontinuation rates.”

    From Adherence and Persistence with GLP-1-Based Therapies: International Real-World Evidence and the Role of Nutritional and Lifestyle Support—A Narrative Review (2026) · cites this paper as [18]

    The Materials and methods (Study Outcomes; page unavailable) define the outcome as medication initiation, not effectiveness or discontinuation. The Discussion (page unavailable) says treatment adherence was beyond the study’s scope. Searches for a real-world-versus-trial effectiveness gap and discontinuation did not find a passage supporting the claim. (LLM, conf=0.76)

    Experimental — accuracy not yet measured

  • Real-world evidence from diverse healthcare systems consistently indicates that a substantial proportion of patients discontinue GLP-1 RA therapy within the first year.

    “real-world evidence from diverse healthcare systems—ranging from the insurance-based models of the United States to the single-payer systems of Scandinavia and the United Kingdom—consistently indicates that a substantial proportion of patients discontinue therapy within the first year [16,18,19,20].”

    From Adherence and Persistence with GLP-1-Based Therapies: International Real-World Evidence and the Role of Nutritional and Lifestyle Support—A Narrative Review (2026) · cites this paper as [18]

    The Materials and methods (Study Outcomes; page unavailable) define the outcome as GLP-1 RA initiation, not discontinuation. The Discussion (page unavailable) says treatment adherence was beyond the study’s scope. Searches for first-year discontinuation and adherence found no passage reporting discontinuation rates or comparisons across healthcare systems. (LLM, conf=0.76)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • White initiators are described as a majority despite a 19.1% share

    Minor

    The results describe most newer-AOM initiators as non-Hispanic White, but give that group a share of only 19.1%. That percentage cannot constitute most initiators.

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Authors
Radwan, R. M., Lee, Y. A., Kotecha, P., Wright, D. R., Hernandez, I., Ramon, R., Donahoo, W. T., Chen, Y., Allen, J. M., Bian, J., & Guo, J.
Affiliations
  • University of Florida (US)
  • Harvard University (US)
  • Division of Clinical Pharmacy Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California La Jolla California USA
  • University of Florida Health (US)
  • University of Pennsylvania (US)
  • Regenstrief Institute (US)
Corresponding author
Guo, Jingchuan
ORCID
Venue
Diabetes Obesity and Metabolism
Publisher
Wiley
Published
2025-03-04
Volume
27
Issue
6
Pages
3113-3123
ISSN
  • 1462-8902 (ISSN-L)
  • 1463-1326
DOI
10.1111/dom.16318
PMC
PMC12049259
OpenAlex
W4408161445
Cited by
24
References
30
Citations by year
2026: 18 · 2025: 6
FWCI
13.48
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Diabetes Obesity and Metabolism (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (publishedVersion)
  • IUScholarWorks (Indiana University) (submittedVersion)
Funders
National Institute of Diabetes and Digestive and Kidney Diseases (R01DK133465)
Topics
  • Health Sciences › Medicine › Pharmacology › Pharmacology and Obesity Treatment
  • Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
Keywords
GLP-1 receptor agonists, anti-obesity drugs, obesity treatment, liraglutide, semaglutide, tirzepatide, health disparities, racial and ethnic disparities, Medicaid, uninsured patients, obesity-related comorbidities, health care utilization
MeSH terms
Liraglutide, Glucagon-Like Peptide-1 Receptor Agonists, Semaglutide, Adult, Glucagon-Like Peptides, Female, Humans, Male, Middle Aged, Obesity, United States, Body Mass Index, Anti-Obesity Agents, Glucagon-Like Peptide 1, Healthcare Disparities

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-09-30.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-09-30.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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