Changewave Research: Alliance Obesity Survey

ChangeWave Research: Alliance Obesity Survey

ChangeWave Research Report:

Alliance Obesity Report

Obesity Still on the Rise – Along With Increased Use of Medications, Treatments and Surgery

Overview

During the week of February 9-14, 2005 we surveyed Alliance healthcare members to see how doctors, patients and the overall industry are dealing with Obesity. A total of 141 healthcare members knowledgeable about Obesity participated in the survey, including 84 doctors.

Increasing Numbers of Obese Patients. Three-in-four doctor respondents (75%) report they have seen an increase in the number of obese patients over the past year – with 27% calling it a “Significant” Increase” and 48% calling it “Moderate.”

Increase in Dangerously/Morbidly Obese Patients. Seventy-one percent (71%) of doctors say they have seen an increase in the number of “Dangerously or Morbidly Obese” patients in the past year (19% “Significant Increase;” 52% “Moderate”).

More Obese Patients Receiving Medication/Treatment/Surgery. An overwhelming 86% of doctors say they have seen an increase in the past year in the number of obese patients receiving medications, treatments or surgery for the disease (24% “Significant Increase;” 62% “Moderate”).

Top Dietary Interventions for Obese Patients. A diet emphasizing a “Reduction in Calories” (70%) is the top dietary intervention doctors typically recommend to persons who are obese but not “Dangerously or Morbidly” obese –followed by a“Diet Program” (e. g. Weight Watchers; 29%) and a “Reduction in Carbohydrates” (25%).

Top Dietary Interventions for Dangerously or Morbidly Obese. A diet emphasizing a “RadicalReduction in Calories” (i.e., 1100-1200 Total Calories Per Day; 38%) is the top dietary intervention doctors typically recommend to “Dangerously or Morbidly”obese individuals.

Dietary Intervention Winners. When asked which dietary intervention will experience the largest increase in popularity among obese patients and recommending physicians over the next year, 44% of doctors chose “A Diet Emphasizing a Reduction in Calories” (44%) –followed by “A Diet Emphasizing a Reduction in Carbohydrates” (26%) and “A Diet Program” (e.g. Weight Watchers; 24%).

Top Weight Control Product. Weight Watchers (44%) is the top weight control product recommended by doctors to obese patients, followed by“Other Weight Loss Programs (e.g., Jenny Craig)” (26%)and Fat Absorption Blockers (17%).

Xenical and Meridia are Top Weight Control Drugs. Xenical(Roche; 29%) and Meridia (Abbott Labs; 19%) are the top drugs that doctors report their practice or clinic recommends to obese patients for weight control.

Optimism About Gastric Surgery Reimbursement. A majority (52%) of doctors believe payors are going to be more willing to reimburse for Gastric Bypass and Gastric Banding surgery over the next 12 months.

Gastric Bypass vs. Gastric Belt. While 29% of doctors see the market for gastric bypass surgery growing faster than the market for gastric banding (gastric belt) surgery, 24% see the opposite occurring. Similarly, doctors report that slightly higher percentages of their Morbidly Obese patients are considering undergoing gastric bypass surgery than gastric banding (gastric belt) surgery.

BiDil’s Prospects. Only 29% of doctors say they have heard of the heart failure drug BiDil. Yetwhen told that BiDil trials were stopped due to overwhelmingly positive results among African American patients, 37% of doctors said they were “Very” or “Somewhat” Likely to recommend it to their African American patients with heart failure, if the drug received FDA approval. Only 8% said they were “Unlikely” to recommend it.

Bottom Line: The survey results provide strong evidence thatthe overall number of obese patients is continuing to rise, including the number of “Dangerously or Morbidly” obese patients. Moreover, doctors overwhelmingly report an increase in the number of obese patients receiving medications, treatments and/or surgery for the disease.

Xenical (29%) and Meridia (19%) are the top drugs doctors report their practice/clinic recommendsto obese patients for weight control. A majority (52%) of doctors also believe insurance payors are going to be more willing to reimburse for Gastric Bypass and Gastric Banding surgery over the next 12 months. In this regard, doctors report a slightly higher percentage of their morbidly obese patients are considering gastric bypasssurgery than gastric banding (gastric belt) surgery.

Diets emphasizing a “Reduction in Calories” (70%) are the primary intervention doctors typically recommend to theirobese patients. However, doctors also reported that their primary intervention for“Dangerously or Morbidly” obese patients is a “RadicalReduction in Calories” (38%).

The ChangeWave Alliance is a group of 5,000 highly qualified business, technology, and medical professionals in leading companies of select industries—credentialed professionals who spend their everyday lives working on the frontline of technological change. ChangeWave surveys its Alliance members on a range of business and investment research and intelligence topics, collects feedback from them electronically, and converts the information into proprietary quantitative and qualitative reports.

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Table of Contents

Summary of Key Findings...... 4

The Findings...... 5

ChangeWave Research Methodology...... 19

About ChangeWave Research...... 20

I. Summary of Key Findings

Introduction

II. The Findings

Total Respondents (n = 141)

Doctor Respondents (n = 84)

All Other Respondents (n=57)

(1) Question Asked: Within your practice or institution, have you seen an increase in the number of Obese patients, a decrease, or has the number of Obese patients remained the same over the past year?

Doctors / All Other
Respondents
Significant Increase in Obese Patients (More Than 10% Increase) / 27% / 32%
Moderate Increase in Obese Patients (1%-10% Increase) / 48% / 40%
Decrease in Obese Patients / 2% / 0%
No Change in the Number of Obese Patients / 19% / 4%
Don't Know / 2% / 5%
Not Applicable / 0% / 16%
No Answer / 1% / 4%

Increasing Numbers of Obese Patients. Three-in-four doctor respondents (75%) report they have seen an increase in the number of obese patients over the past year – with 27% calling it a “Significant” Increase” and 48% calling it “Moderate.” Only 2% say they have seen a decrease.

(2) Question Asked: Within your practice or institution, have you seen an increase in the number of Dangerously or Morbidly Obese patients, a decrease, or has the number of Dangerously or Morbidly Obese patients remained the same over the past year?

Doctors / All Other
Respondents
Significant Increase in Dangerously or Morbidly Obese Patients(More than 10% Increase) / 19% / 14%
Moderate Increase in Dangerously or Morbidly Obese Patients (1%-10% Increase) / 52% / 44%
Decrease in Dangerously or Morbidly Obese Patients / 6% / 0%
No Change in the Number of Dangerously or Morbidly Obese Patients / 19% / 12%
Don't Know / 4% / 11%
Not Applicable / 0% / 16%
No Answer / 0% / 4%

Increase in Dangerously/Morbidly Obese Patients. Seventy-one percent (71%) of doctors say they have seen an increase in the number of “Dangerously or Morbidly Obese” patients in the past year (19% “Significant Increase;” 52% “Moderate”).

(3) Question Asked:Above and beyond dietary interventions, have you seen an increase in the number of Obese patients receiving medications, treatments or surgery to treat Obesity, a decrease, or has the number of Obese patients receiving medications, treatments or surgery remained the same over the past year?

Doctors / All Other
Respondents
Significant Increase in Obese Patients Receiving Medications, Treatments or Surgery (More than 10% Increase) / 24% / 21%
Moderate Increase in Obese Patients Receiving Medications, Treatments or Surgery (1%-10% Increase) / 62% / 44%
Decrease in Obese Patients Receiving Medications, Treatments or Surgery / 0% / 2%
No Change in the Number of Obese Patients Receiving Medications, Treatments or Surgery / 11% / 5%
Don't Know / 2% / 11%
Not Applicable / 0% / 14%
No Answer / 1% / 4%

Patients Receiving Non-Dietary Medications, Treatments or Surgery Increased. Eighty-six percent (86%) of doctors say they have seen an increase in the number of Obese patients receiving medications, treatments or surgery to treat the disease, with 24% saying “Significant” and 62% saying “Moderate.”

(4) Question Asked:What percentage of your practice or clinic's Obese patient population would you estimate are currently receiving medications and/or other treatments for Obesity, or have undergone surgery for Obesity?

Doctors / All Other
Respondents
1-10% / 42% / 16%
11%-25% / 24% / 19%
26%-50% / 7% / 11%
Greater than 50% / 6% / 5%
Don't Know / 14% / 19%
Not Applicable / 7% / 26%
No Answer / 0% / 4%

Percentage of Obese Patients Receiving Medications, Treatments or Surgery.Forty-two percent (42%) of doctors report that 1-10% of their practice or clinic’s Obese patients are currently receiving medications, treatment, or have had surgery for Obesity. Another 37% reportthat more than 10% of their Obese patients are receiving Medications/Treatments or have had surgery.

(5) Question Asked:Which of the following dietary interventions would you most typically recommend to persons who are Obese but not Dangerously or Morbidly Obese (i.e., have a medical need to lose weight, but are not diabetic and do not suffer from coronary heart disease)? (Choose No More Than Two)

Doctors / All Other
Respondents
A Diet Emphasizing a Reduction in Calories / 70% / 49%
A Diet Program (e.g. Weight Watchers) / 29% / 21%
A Diet Emphasizing a Reduction in Carbohydrates / 25% / 19%
Any Diet the Patient has Used Successfully in the Past / 15% / 14%
A Diet Emphasizing a Reduction in Fat Intake / 13% / 23%
A Diet Emphasizing a Radical Reduction in Calories (i.e., 1100-1200 Total Calories Per Day) / 12% / 14%
A Diet Emphasizing Supplements (Slimfast, Medifast) / 4% / 4%
Don't Know / 1% / 9%
Other / 7% / 12%

Top Dietary Interventions for Non-Morbidly Obese. “A Diet Emphasizing a Reduction in Calories” (70%) is the top dietary intervention doctors typically recommend to persons who are obese but not “Dangerously or Morbidly” obese –followed by a“Diet Program” (e. g. Weight Watchers; 29%) and a “Reduction in Carbohydrates” (25%).

While “A Diet Emphasizing a Reduction in Calories” (49%) is also the top response among all other respondents, “A Diet Emphasizing a Reduction in Fat Intake” (23%) is second, followed by “A Diet Program” (e. g. Weight Watchers; 21%) and “A Diet Emphasizing a Reduction in Carbohydrates” (19%).

(5A) Question Asked: Which of the following dietary interventions would you most typically recommend to persons who are Dangerously or Morbidly Obese?(Choose No More Than Two)

Doctors / All Other
Respondents
A Diet Emphasizing a Radical Reduction in Calories
(i.e., 1100-1200 Total Calories Per Day) / 38% / 33%
A Diet Emphasizing a Reduction in Calories / 35% / 23%
A Diet Program (e.g. Weight Watchers) / 35% / 33%
A Diet Emphasizing a Reduction in Carbohydrates / 20% / 14%
A Diet Emphasizing a Reduction in Fat Intake / 10% / 16%
A Diet Emphasizing Supplements (Slimfast, Medifast) / 7% / 4%
Any Diet the Patient has Used Successfully in the Past / 6% / 11%
Don't Know / 0% / 9%
Other / 17% / 18%

Top Dietary Interventions for Dangerously or Morbidly Obese. A diet emphasizing a “RadicalReduction in Calories” (i.e., 1100-1200 Total Calories Per Day; 38%) is the top dietary intervention doctors typically recommend to “Dangerously or Morbidly” obese individuals. “A Diet Emphasizing a Reduction in Calories” (35%) and “A Diet Program” (e.g., Weight Watchers; 35%) tied for second.

Among All Other Respondents, “A Diet Program” (e.g. Weight Watchers; 33%) tied with

“A Diet Emphasizing a Radical Reduction in Calories” (i.e., 1100-1200 Total Calories Per Day; 33%) as the top dietary interventionmost typically recommended to persons who are Dangerously or Morbidly Obese.

(5B) Question Asked: Over the next year, which of the following dietary interventions do you think will experience the largest increase in popularity among Obese patients and recommending physicians? (Choose No More Than Two)

Doctors / All Other
Respondents
A Diet Emphasizing a Reduction in Calories / 44% / 40%
A Diet Emphasizing a Reduction in Carbohydrates / 26% / 16%
A Diet Program (e.g. Weight Watchers) / 24% / 28%
A Diet Emphasizing a Reduction in Fat Intake / 17% / 12%
A Diet Emphasizing Supplements (Slimfast, Medifast) / 12% / 12%
Any Diet the Patient has Used Successfully in the Past / 10% / 9%
A Diet Emphasizing a Radical Reduction in Calories (i.e., 1100-1200 Total Calories Per Day) / 8% / 16%
Don't Know / 15% / 14%
Other / 6% / 4%

Dietary Intervention Winners – Next Year. When asked which dietary intervention will experience the largest increase in popularity among obese patients and recommending physicians over the next year, 44% of doctors chose “A Diet Emphasizing a Reduction in Calories” (44%) –followed by “A Diet Emphasizing a Reduction in Carbohydrates” (26%) and “A Diet Program” (e.g. Weight Watchers; 24%).

(6) Question Asked: Which of the following OTC supplements or weight control products does your practice or clinic recommend to obese patients? (Check All That Apply)

Doctors / All Other
Respondents
Weight Watchers / 44% / 35%
Other Weight Loss Programs (i.e Jenny Craig) / 26% / 18%
Fat Absorption Blockers / 17% / 14%
Medifast / 14% / 4%
SlimFast / 13% / 9%
Appetite Suppressants (e.g., Xenadrine, Dexatrim) / 8% / 12%
Other Diet Supplements (e.g. Cortisol, Acutrim Natural, Twinlab Diet Fuel) / 4% / 0%
Ephedrine Based Products / 0% / 4%
Don't Know / 14% / 39%
Other / 15% / 7%

Top Weight Control Product. Weight Watchers (44%) is the top weight control product recommended by doctors to obese patients, followed by “Other Weight Loss Programs (e.g., Jenny Craig)” (26%) and Fat Absorption Blockers (17%).

(6A) Question Asked: And which of the following pharmaceuticals for weight control does your practice or clinic recommend to obese patients? (Note: If you prescribe the generic form, please check the brand name). (Check All That Apply)

Doctors / All Other
Respondents
Xenical / 29% / 21%
Meridia / 19% / 16%
Adipex / 6% / 7%
Phentermine / 6% / 12%
Bontril / 5% / 0%
Tenuate / 5% / 4%
Fastin / 4% / 7%
Ionamin / 4% / 2%
Didrex / 1% / 2%
Don't Know / 30% / 47%
Other / 18% / 9%

Xenical and Meridia are Top Weight Control Drugs. Xenical(Roche; 29%) and Meridia (Abbott Labs; 19%) are the top drugs that doctors report their practice or clinic recommends to obese patients for weight control.

(7) Question Asked: Gastric Bypass surgery and Adjustable Gastric Banding (gastric belt) surgery are both used to reduce the ability of patients to consume food. Which of the following statements best reflects your opinion on the relative market growth of these two procedures?

Doctors / All Other
Respondents
The market for gastric bypass surgery is growing faster than the market for adjustable gastric banding (gastric belt) surgery / 29% / 25%
The market for gastric bypass surgery is growing slower than the market for adjustable gastric banding (gastric belt) surgery / 24% / 16%
The market for gastric bypass surgery is growing the same as the market for adjustable gastric banding (gastric belt) surgery / 13% / 16%
Don't Know / 35% / 35%
No Answer / 0% / 9%

Gastric Bypass vs. Gastric Belt. While 29% of doctors see the market for gastric bypass surgery growing faster than the market for gastric banding (gastric belt) surgery, 24% see the opposite occurring. Another 13% see the two markets growing the same.

(7A) Question Asked: New Medicare guidelines announced in July 2004 removed language that stated Obesity is not a disease. Yet the final decision has not yet been made on whether Medicare policies will be changed regarding coverage for Bariatric surgery - including Gastric Bypass and Gastric Banding surgery.

How would you characterize the willingness of payors to reimburse for Gastric Bypass and Gastric Banding (gastric belt) surgery over the next 12 months?

Doctors / All Other
Respondents
Payors Will Be Significantly More Willing to Reimburse / 12% / 11%
Payors Will Be Somewhat More Willing to Reimburse / 40% / 40%
There Will Be No Change in Payor Willingness to Reimburse / 19% / 18%
Payors Will Be Less Willing to Reimburse / 6% / 2%
Don't Know / 21% / 25%
Other / 1% / 5%

Optimism About Gastric Surgery Reimbursement. A majority (52%) of doctors believe payors are going to be more willing to reimburse for Gastric Bypass and Gastric Banding surgery over the next 12 months (12% “Significantly More Willing” and 40%“Somewhat”). Only 6% say payors are going to be less willing to reimburse.

(7B) Question Asked:What percentage of your practice or clinic's patients that are Dangerously or Morbidly Obese would you estimate have already undergone Gastric Bypass or Gastric Banding (gastric belt) surgery?

Doctors / All Other
Respondents
1-5% / 52% / 30%
6-10% / 12% / 5%
11%-25% / 4% / 9%
26%-50% / 2% / 4%
Greater than 50% / 0% / 0%
Don't Know/ No Answer / 18% / 30%
Not Applicable / 12% / 23%

Morbidly Obese Patients and Gastric Surgery. Eighteen percent (18%) of doctors report that greater than 5% of their morbidly obese patients have already had gastric surgery. But a majority of doctors (52%) report that only 1-5% of their morbidly obese patients have had gastric surgery.

(8) Question Asked:Currently, what percentage of your practice or clinic's patients that are Dangerously or Morbidly Obese would you estimate are considering undergoing Gastric Bypass surgery?

Doctors / All Other
Respondents
1-5% / 26% / 11%
6-10% / 25% / 12%
11%-25% / 14% / 9%
26%-50% / 2% / 9%
Greater than 50% / 1% / 2%
Don't Know / 22% / 32%
Not Applicable / 8% / 26%

Four-in-ten doctors (41%) report that more than 5% of their practice or clinic's Dangerously or Morbidly Obese patients are considering undergoing Gastric Bypass surgery.

(8A) Question Asked:And currently, what percentage of your practice or clinic's patients that are Dangerously or Morbidly Obese would you estimate are considering undergoing Gastric Banding (gastric belt) surgery?

Doctors / All Other
Respondents
1-5% / 33% / 5%
6-10% / 10% / 12%
11%-25% / 11% / 5%
26%-50% / 4% / 4%
Greater than 50% / 1% / 2%
Don't Know / 33% / 35%
Not Applicable / 8% / 26%
No Answer / 0% / 11%

One-in-four doctors (26%) report that more than 5% of their practice or clinic's Dangerously or Morbidly Obese patients are considering undergoing Gastric Banding surgery.

Gastric Bypass vs. Gastric Belt. In sum, doctors report that slightly higher percentages of their Morbidly Obese patients are considering undergoinggastric bypasssurgery than gastric banding (gastric belt)surgery.

These last few questions were on BiDil, a heart disease drug from Nitromed.

(9) Question Asked:The drug BiDil, made by Nitromed, has shown positive results for treating African Americans with heart failure in late stage trials. Have you heard of BiDil?

Doctors / All Other
Respondents
Yes / 29% / 25%
No / 70% / 68%
No Answer / 1% / 7%

(9A) Question Asked:Recently (July 2004), BiDil trials were stopped due to overwhelmingly positive results in a sample of African Americans. The drug is now awaiting FDA approval. If this drug were to be approved, what is the likelihood you would recommend or prescribe it as a treatment for your African American patients with heart failure?

Doctors / All Other
Respondents
Very Likely / 20% / 9%
Somewhat Likely / 17% / 14%
Somewhat Unlikely / 4% / 2%
Very Unlikely / 4% / 0%
Don't Know / 19% / 28%
Not Applicable / 31% / 35%
No Answer / 6% / 12%

BiDil’s Prospects. Only 29% of doctors say they have heard of the heart failure drug BiDil. Yetwhen told that BiDil trials were stopped due to overwhelmingly positive results among African American patients,37% of doctors said they were “Very” or “Somewhat” Likely to recommend it to their African American patients with heart failure, if the drug received FDA approval. Only 8% said they were “Unlikely” to recommend it.