Digital Clinical Decision Support Improves Treatment for Patients With Obesity

With the use of digital clinical decision support (eCDS), pharmacists demonstrated the ability to better assist patients with obesity in achieving optimal treatment, according to a study published in JAPhA Practice Innovations.¹ By having the eCDS adjust medication orders to patients’ weight and body mass index (BMI), researchers supported the technology’s use to improve pharmacotherapy among patients with obesity.

“Patients with obesity and severe obesity have an excessive amount of adipose tissue and several physiological changes occur to support this tissue,” wrote the authors of the study. “The physiological changes may alter the pharmacokinetics and dynamics of drugs: absorption, distribution, and elimination of drugs may be affected. This requires dose adjustments for certain drugs in [patients with obesity], because in standard drug dosing for adults, BMI or body weight (BW) is not used for dose calculation, and registered doses are based on average BMI/BW.”

READ MORE: Higher BMI Associated With Lower All-Cause Mortality

In many health care sectors treating conditions across a variety of patient populations, drug dosing and body weight are often connected. There is an approach to fixed-dosing regimens, where patients receive drug doses based on factors aside from weight or BMI. However, weight-based or body surface area-based dosing has often been applied to better ensure safe interactions between patients and their prescriptions.²

The eCDS tool can help pharmacists and other providers personalize their dosing recommendations toward specific patients. | image credit: weerasak / stock.adobe.com

According to GoodRx, weight-based dosing is employed for providers to determine their patients’ personalized and appropriate dosing recommendations for their prescriptions.³ However, for patients reporting obesity and higher-than-average BMIs, weight-based dosing can come with barriers.

“These folks are particularly important because these patients are often not well represented in the clinical trials or the pharmacokinetic studies that are done that ultimately lead to the doses that are in product labels or package inserts,” Jeffrey F. Barletta, PharmD, FCCM, said in an article published by Wolters Kluwer.⁴

With previous dosing recommendations being generalized medication dosing regimens across populations, weight-based dosing made it difficult for providers to personalize their patients’ treatment plans. As obesity rates continue to rise, these issues open the door for eCDS as a tool integrated with the electronic health record (EHR) to support providers with targeted knowledge in making clinical decisions.

While tools like the eCDS have been significantly implemented with the introduction of EHRs, their use in dosing recommendations remains underexplored, especially among patients with obesity. This lack of knowledge forced researchers to urge further exploration of weight-based dosing and the use of eCDS.⁵

“The aim of this study was to examine the extent to which eCDS led to pharmacotherapeutic interventions and adjustments in the treatment of patients with obesity,” wrote theauthors of the current study.¹

Researchers conducted a prospective intervention study including hospitalized adults with a BMI of at least 30 kg/m² and a BW of at least 90 kg. The study was conducted during 2 separate timeframes. The first was the pre-eCDS period lasting from January 1 to September 30, 2022, and the post-eCDS period lasted from October 10 to November 25, 2022.

The study’s main outcome was the prevalence of medication orders that were adjusted for BMI or BW, comparing the pre- and post-eCDS periods with each other. Aside from this comparison, researchers also sought to determine physician acceptance rates, the occurrence of treatment failure or adverse events, and the prevalence of post-eCDS patients specifically being prescribed at least 1 medication with a recommendation to adjust for BMI or BW.

The final analysis included a total of 5232 patients, with 4428 (49.6% men; mean age, 58 years) separated into the pre-eCDS group and 804 participants (52.4% men; mean age, 58.7 years) in the post-eCDS group.

“The proportion of medication orders that were adjusted to BMI or BW in accordance with dosing guidelines significantly increased from 58.2% to 77.7% after implementation of eCDS that was used by hospital pharmacy to advise attending physicians on drug dosages in hospitalized patients with obesity,” the study authors continued.¹ “This study showed that eCDS provides an opportunity to improve pharmacotherapy in patients with obesity.”

On top of the increase in adjustments from the pre-eCDS to post-eCDS period, researchers also uncovered that 328 patients (41%) had at least 1 medication order with a recommendation, tallying a total of 349 pharmacotherapeutic recommendations.

Through use of eCDS, pharmacists have the opportunity to further personalize medicine for their patients. With personalized medicine shying away from a “one-size-fits-all” approach, tools like eCDS can only bolster pharmacists’ knowledge of their patients and make more informed clinical decisions, especially in populations with obesity or overweight because of their interactions with specific drug doses.⁶

“This study showed that eCDS offers the potential to significantly improve the proportion of medication orders adjusted to BMI or BW in hospitalized obese patients,” concluded the authors.¹ “Combining eCDS with education seems an interesting next step towards optimal pharmacotherapy for the growing obese population.”

READ MORE: Obesity Management Resource Center

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REFERENCES

1. Keyany A, Groenen I, Saini S, et al. Digital clinical decision support to improve pharmacotherapy in hospitalized obese patients: a prospective intervention study. JAPhA Pract Innov. August 8, 2025:100077. https://doi.org/10.1016/j.japhpi.2025.100077

2. Pai MP. Drug dosing based on weight and body surface area: mathematical assumptions and limitations in obese adults. Pharmacotherapy. 2012 Sep;32(9):856-68. doi: 10.1002/j.1875-9114.2012.01108.x.

3. Clayton J, Woodcock S. Weight-based dosing: what to know about medication dosages and body weight. GoodRx. February 9, 2023. Accessed September 9, 2025. https://www.goodrx.com/drugs/medication-basics/weight-based-medication-dosage?srsltid=AfmBOoqFmNCFIyYnagisGiuS3u-8uRlPyBM1WZj2sBjgpLCqOIb-wiqm

4. Weight-based dosing: Webinar examines clinical challenges. Wolters Kluwer. December 12, 2022. Accessed September 9, 2025. https://www.wolterskluwer.com/en/expert-insights/weight-based-dosing-webinar-examines-clinical-challenges

5. Jing X, Himawan L, Law T. Availability and usage of clinical decision support systems (CDSSs) in office-based primary care settings in the USA. BMJ Health Care Inform. 2019 Dec;26(1):e100015. doi: 10.1136/bmjhci-2019-100015.

6. Stefanicka-Wojtas D, Kurpas D. Personalised medicine-implementation to the healthcare system in Europe (focus group discussions). J Pers Med. 2023 Feb 21;13(3):380. doi: 10.3390/jpm13030380.