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General Paediatrics
Original article
Survey of antiobesity drug prescribing for obese children and young people in UK primary care
  1. Billy White1,2,
  2. Yingfen Hsia3,
  3. Sanjay Kinra4,
  4. Sonia Saxena5,
  5. Deborah Christie6,7,
  6. Russell M Viner1,2,
  7. Ian C K Wong8
  1. 1 Department of Population Health Sciences, UCL Institute of Child Health, London, UK
  2. 2 Department of Adolescent Medicine, University College London Hospital, London, UK
  3. 3 Paediatric Infectious Diseases Research Group, St George’s University of London, London, UK
  4. 4 Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
  5. 5 Department of Primary Care and Public Health, Imperial College London, London, UK
  6. 6 Department of Child and Adolescent Psychological Services, University College London Hospital, London, UK
  7. 7 Department of Epidemiology and Public Health, UCL, London, UK
  8. 8 Centre for Paediatric Pharmacy Research, UCL School of Pharmacy, London, UK
  1. Correspondence to Dr Billy White; billy.white{at}ucl.ac.uk

Abstract

Objectives Antiobesity drug (AOD) prescribing in children and young people (CYP) in primary care is rising with high rates of discontinuation. Little is known about prescribing in this group in terms of patient demographics and comorbidities, reasons for initiation and discontinuation, or adherence to national guidelines.

Design Questionnaire survey to general practitioners (GPs) identified using a nationally representative primary care database covering 6% of UK population.

Setting UK-wide primary care.

Participants Patients were eligible if prescribed an AOD aged ≤18 years between 2010 and 2012. A total of 151 patients from 108 unique practices were identified via national prescribing database, with responses for 119 patients (79%) from 84 practices; 94 of 119 (79%) were eligible for inclusion.

Primary and secondary outcomes Survey of GP prescribing habits of AODs to CYP. We audited orlistat usage against the National Institute for Health and Care Excellence (NICE) guidance.

Results 47% were prescribed metformin, 59% orlistat and 5% both drugs. Orlistat was largely prescribed by GPs independently (49/55 prescriptions, 89%) and metformin by GPs on specialist recommendation (12/44, 27%). Orlistat was largely prescribed in those over 16 years of age without physical comorbidities. Metformin was initiated for treatment of polycystic ovarian syndrome (70%), insulin resistance (25%) and impaired glucose control (9%). Median supply of metformin was 10.5 months (IQR 4–18.5 months) and 2.0 months (1.0–4.0) for orlistat (p≤0.001). Drug terminations were largely due to families not requesting repeat prescriptions. NICE guidance adherence was low; 17% of orlistat prescriptions were initiated by specialists, and 56% had evidence of obesity-related comorbidity. GPs reported lower confidence in prescribing AOD to CYP compared with adults (10-point Likert score median 3 vs 8, p<0.001).

Conclusions Prescribing of AOD in primary care is challenging with low adherence to NICE guidance. Further work is needed to better support GPs in the use of AOD in CYP.

  • obesity
  • adolescent health

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

https://doi.org/10.1136/bmjpo-2017-000104

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    Footnotes

    • Contributors BW devised the questionnaire with support from all authors and coordinated data collection. YH collated the data set from GP responses. BW analysed and interpreted the data set. BW and RV wrote the manuscript. All authors reviewed and contributed towards the final manuscript. All authors were involved in writing the paper and had final approval of the submitted and published versions.

    • Funding This work was supported by funding from the National Institute for Health Research (NIHR) in England under its Programme Grants for Applied Research (RP-PG-0608–10035).

    • Competing interests None declared.

    • Ethics approval This study was reviewed and approved by the NRES Committee London – Surrey Borders REC reference number11/LO/1020.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Original data are available from the authors.