Abstract Body (Do not enter title and authors here): Introduction:
Recent advances in obesity treatment added incretin-based injectables like semaglutide to treatments ranging from lifestyle modification to bariatric surgery. While the burden of obesity in the United States is high and disproportionately affects minoritized individuals, obesity interventions may not be equitably distributed. Insurance coverage is often cited as a barrier to accessing novel treatments.

Research Question:
Do inequities in semaglutide use among patients with obesity persist without insurance barriers to care?

Goals:
Characterize the role of race and ethnicity in the receipt of semaglutide among Veterans with obesity.

Methods:
Among VA patients with BMI ≥27 from 2018-2023, we used a hierarchical multivariable mixed effects logistic regression model to evaluate the association between race and ethnicity (White, Non-Hispanic Black, Hispanic, Asian/Native Hawaiian/Pacific Islander, American Indian/Alaska Native) and receipt of semaglutide prescriptions. We adjusted for age, gender, diabetes status, Charlson Comorbidity Index, education, and urbanicity, with a random effect for diagnosis year.

Results:
Among Veterans with BMI ≥27 (n=2,423,070), 38.8% had Class I obesity (BMI 30-34.9), 18.2% had Class II obesity (BMI 35-39.9), and 9.8% had Class III obesity (BMI>40), with differences by race and ethnicity (p<0.01). Across the cohort, 184,690 (7.6%) received at least one prescription for semaglutide during the study period. Higher severity of obesity was associated with odds of semaglutide prescription (Figure). Compared to White Non-Hispanic patients, Black and Hispanic/Latino Veterans were less likely to receive a semaglutide prescription, with adjusted odds ratios (AOR) of 0.63 (95% confidence interval [CI]): 0.60-0.68) and 0.81 (95% CI: 0.74-0.90), respectively. Receipt of a semaglutide prescription was also highly associated with diabetes status, with an AOR of 35.2 (95% CI 32.5-38.0) for those with a diagnosis of diabetes compared to those without.

Conclusions:
Racial and ethnic minority Veterans with obesity are less likely to receive prescriptions for semaglutide in VA, suggesting that challenges to equitable obesity care are more complex than financial coverage alone.