Active-duty service members increasingly have been prescribed weight loss medications since 2018, when the Defense Department authorized insurance coverage of those drugs. (Edward Garibay/U.S. Army)
Weight-loss prescriptions for U.S. service members remain low but have risen sharply since 2018, when the Defense Department began authorizing coverage of medications for active-duty troops struggling with weight control, according to a first-of-its-kind study.
Monthly prescriptions across all services rose from seven in January 2018 to 816 in June 2023, an analysis of DOD electronic health records during that same period shows.
The data was published in the most recent Medical Surveillance Monthly Report, a peer-reviewed journal of the Armed Forces Health Surveillance Division.
“The findings indicate a significant rise in the … prevalence of weight loss prescriptions over time,” the report said, including a four-fold increase in 2022.
That trend corresponds to the Defense Health Agency approval of semaglutide in 2021 for weight management. Sold under the brand names Ozempic and Wegovy, the drug was originally approved by the Food and Drug Administration for diabetes. It was later shown to suppress appetite.
The number of monthly prescriptions across all services for weight-loss drugs, such as Wegovy, rose from seven in January 2018 to 816 in June 2023. (Novo Nordisk via AP)
The surveillance study looked at a wide range of demographics and characteristics, including sex, age, service, race, rank, occupation, history of type 2 diabetes and body mass index. Among the findings: higher prescription rates were associated with women, service members over 40, Black non-Hispanic personnel, those in the Navy and health care workers.
By rank, senior personnel had higher rates of prescriptions for weight-loss drugs, peaking in the spring of 2023, at 307 prescriptions per 100,000 for officers in the pay grades of O-4 and above. The rate was 145.7 per 100,000 people for enlisted members above E-5.
During the same period, April to June 2023, the rate of prescriptions for Navy personnel was 157.1 per 100,000, compared to 43.2 in the Marine Corps. For the Army and Air Force, the rates were 91.3 and 101.7, respectively.
In general, some of the trends correlated with obesity prevalence in the U.S. military, the study said, including ethnicity and age, and by service, where the Navy has the highest rate, the report said.
But not all findings corresponded to previously observed obesity rates. For example, men in the military tend to be more overweight compared to women, and among professions, obesity is seen more among repair and engineering occupations than the health care field, according to the study.
The National Defense Authorization Act of 2017 allowed weight loss drugs to be part of the pharmacy benefit under Tricare for medically necessary treatment of obesity.
Patients must get prior authorization from their doctor and have a body mass index higher than 29, or 26 if they have a related condition such as hypertension, diabetes or sleep apnea. Lifestyle changes such as diet modifications and exercise are required six months prior to starting therapy.
Phentermine comprised the largest number of prescriptions throughout the surveillance period, the report found. But a significant portion were seen later from semaglutide, the study found.
The report recommended further study to evaluate the effectiveness of the drugs “in weight management and safety for use among service members in austere and deployed environments.”
