The impact of obesity on drug prescribing in primary care

Background

Healthcare costs attributable to obesity have previously involved estimations based on costs of diseases commonly considered as having obesity as an underlying factor.

Aim

To quantify the impact of obesity on total primary care drug prescribing.

Design of study

Review of computer generated and handwritten prescriptions to determine total prescribing volume for all drug classes.

Setting

Twenty-three general practice surgeries in the UK.

Method

Stratified random selection of 1150 patients who were obese (body mass index [BMI]>30 kg/m2) and 1150 age- and sex-matched controls of normal weight (BMI 18.5–<25 kg/m2). Retrospective review of medical records over an 18-month period.

Results

A higher percentage of patients who were obese, compared with those of normal weight, were prescribed at least one drug in the following disease categories: cardiovascular (36% versus 20%), central nervous system (46% versus 35%), endocrine (26% versus 18%), and musculoskeletal and joint disease (30% versus 22%). All of these categories had a P-value of <0.001. Other categories, such as gastrointestinal (24% versus 18%), infections (42% versus 35%), skin (24% versus 19%) had a P-value of <0.01, while respiratory diseases (18% versus 21%) had a P-value of <0.05. Total prescribing volume was significantly higher for the group with obesity and was increased in the region of two- to fourfold in a wide range of prescribing categories: ulcer healing drugs, lipid regulators, β-adrenoreceptor drugs, drugs affecting the rennin angiotensin system, calcium channel blockers, antibacterial drugs, sulphonylureas, biguanides, non-steroidal anti-inflammatories (NSAIDs) (P<0.001) and fibrates, angiotensin II antagonists, and thyroid drugs (P<0.05). The main impact on prescribing volumes is from numbers of patients treated, although in some areas there is an effect from greater dosage or longer treatment in those who are obese including calcium channel blockers, antihistamines, hypnotics, drugs used in the treatment of nausea and vertigo, biguanides, and NSAIDs (P<0.05) reflected in significantly increased defined daily dose prescribing.

Accounting for habitat and seafloor structure characteristics on southern rock lobster (Jasus edwardsii) assessment in a small marine reserve

Where to place marine protected areas (MPAs) and how much area they should cover are some of the most basic questions when designing MPAs. Based on the theory of island biogeography, larger reserves are likely to protect more species and individuals but smaller reserves have been shown to positively influence populations. In this study, we assess a localised population of the ecologically and economically important southern rock lobster (Jasus edwardsii) inside and outside a small reserve. We used standardised fishery assessment trapping methods to sample J. edwardsii populations inside a reserve and an adjacent area outside the reserve. The population characteristics of the captured individuals were compared inside and outside the reserve using t tests (male size, female size,number of reproductive females, number of individuals and biomass), and we found that there were significantly greater numbers and larger individuals and biomass inside the reserve. However, many assessments of MPA effectiveness are confounded by differences in habitat. To account for possible differences in habitat, we collected multibeam bathymetry data to allow us to characterise seafloor structure and video data to assign each sampling location to a biotope class based on macroalgae assemblages. Then, using generalised linear models (GLMs), we assessed differences in populations while accounting for habitat. The GLMs revealed that there was still a significant difference in populations inside the reserve despite habitat differences inside and outside the reserve. We demonstrate a methodological approach to provide a baseline data set to assess MPA effectiveness through time and measure how habitat may respond to indirect consequences of fishing or other human impacts at the species or ecosystem level. We also highlight some of the limitations in sampling design and data availability common in MPA studies and resulting implications for assessment.