By Patricia Kime

Active duty troops and TRICARE beneficiaries now have access to a new tool in the battle of the bulge: FDA-approved weight-loss drugs that curb appetite, boost metabolism, or block absorption of starches and fats.

The Defense Health Agency (DHA) in May added four generic weight-loss medications to DoD's pharmacy formulary -- phentermine, benzphetamine, diethylpropion, and phendimetrazine - and said it would cover several other medications, including liraglutide, lorcaserin, and orlistat, under certain circumstances.

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The idea is to make more FDA-approved weight-loss therapies available to TRICARE patients but also give active duty personnel struggling with weight some alternatives for meeting standards, explained Dr. Donald Shell, director for disease prevention, disease management, and population health policy and oversight in the office of the Assistant Secretary of Defense for Health Affairs.

“It's clear from the scientific literature, if you can reduce excess body fat in the individual then you lower their risk of comorbid diseases related to excess body fat … this is the general literature, not specific to DHA or Health Affairs, but a 5 to 10 percent reduction in body weight can lower blood pressure, decrease insulin requirements for diabetics. It's in the best interest for preventing major chronic diseases,” Shell said.

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Survey results released this year by RAND Corp. found that nearly 15 percent of U.S. troops were obese in 2015, meaning they had a body mass index of 30 or higher. An additional 51 percent were clinically overweight, registering BMIs between 25 and 25.9, although the report noted that in some cases of troops with high muscle mass, BMI is an inadequate measure of body composition and fitness.

Among all DoD beneficiaries, which includes family members, retirees and their family members, the prevalence of obesity has reached 23 percent, according to the Health Care Survey of DoD Beneficiaries.

While obesity levels in the military are lower than the general U.S. population (a third of whom fall under the clinical definition of obese), they can have a significant impact on readiness, RAND analysts noted.

“Service members who do not maintain their physical readiness may not be able to complete their assigned tasks,” they wrote. “Overweight or obese personnel reduce overall force fitness … and pose policy issues for military recruitment, retention and standards used to qualify or disqualify individuals from service.”

[UPDATED MONTHLY: MOAA's TRICARE Toolkit]

To be considered for weight-loss medication prescription under TRICARE or the Military Health System, patients must have a BMI higher than 29, or 26 if they have a related condition such as diabetes, high blood pressure, or sleep apnea.

Obtaining a prescription will take commitment under the new policy. The drugs require prior authorization, and patients will be required to participate in behavior modification, to include dietary changes and exercise, for at least six months before receiving the medication. They must continue these lifestyle changes while taking the drugs.

Active duty troops must also be enrolled in their service-specific health and wellness program and adhere to their service's policies.

DHA has instituted a step-therapy approach to prescribing the medications that starts with a three-month trial of generic phentermine for most patients. If a patient does not lose 5 percent of their weight while on phentermine, they may be prescribed another medication, including one of the non-formulary drugs. Within that category, there are similar recommendations for step therapy, starting with the lower cost medications.

Gastric bypass and other weight loss surgery is available for military dependents who are extremely overweight and unable to shed pounds by diet and exercise. DoD policy bars active duty personnel from receiving these types of surgeries.

Weight-loss medications are another tool for personnel who struggle to meet military standards and want to continue to serve, Shell said. “Service members who are evaluated in an MTF and deemed to be appropriate for a weight-loss medication also have to be approved by the senior leadership within their service.”