Prevalence of Obesity Medications in the Military Health System: An Update from 2022.

INTRODUCTION: Obesity poses an increasing threat to U.S. military readiness, with over half of active-duty service members classified as overweight and up to 27% with obesity. Within the Military Health System (MHS), obesity contributes to service disqualification, musculoskeletal injury, and cardiometabolic disease, accounting for an estimated $2 billion annually in combined costs. Although TRICARE began covering obesity medications (OMs) in 2018, prior analyses demonstrated limited utilization. With policy changes in September 2024 that streamlined access and the introduction of newer agents such as semaglutide (Wegovy) and tirzepatide (Zepbound), this study examined updated prescribing trends and predictors of OM use from fiscal years (FY) 2023-2024. MATERIALS AND METHODS: This cross-sectional study analyzed demographic, clinical, and pharmacy claims data from the MHS Data Repository for adult TRICARE Prime and Plus beneficiaries ages 18-64, without type 1 or type 2 diabetes, and with a body mass index (BMI) of 27 or higher. The primary outcome was receipt of one or more TRICARE-approved OMs, excluding formulations approved for diabetes. Descriptive statistics and multivariable logistic regression identified predictors of OM use by sex, age, race/ethnicity, beneficiary category, rank, comorbidity status (prediabetes, metabolic syndrome, coronary artery disease, obstructive sleep apnea), and care setting. RESULTS: Among 568,232 BMI-eligible adult beneficiaries, 31,176 (5.5%) received at least one OM. OM users were predominantly female (81%), ages 30-59 years, and dependents (71%). Half had a primary care manager in direct care and half in the private sector. Most prescribed agents were phentermine (41%), semaglutide (Wegovy, 28%), naltrexone/bupropion (20%), phentermine/topiramate (16%), and tirzepatide (Zepbound, 15%). Female sex (OR = 4.07) and senior enlisted rank (OR = 1.13) were associated with significantly (P < .05) higher odds of use; Asian/Pacific Islander (OR = 0.59), Hispanic (OR = 0.81), Black (OR = 0.82), and active-duty (OR = 0.64) beneficiaries had significantly (P < .05) lower odds. CONCLUSIONS: Obesity medication utilization in the MHS increased modestly since 2018 but remains low relative to disease prevalence, particularly among active-duty and minority beneficiaries. Recent TRICARE coverage changes may further shape access and prescribing patterns, though their downstream effects on health outcomes, readiness, and costs remain uncertain. These findings highlight ongoing knowledge gaps regarding the optimal, sustainable use of OM in the MHS and underscore the need for MHS-specific effectiveness, safety, and cost-effectiveness data to inform evidence-based, readiness-aligned obesity care strategies.