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Aug. 27, 2014 -- Obesity costs the U.S. health-care system close to $150 billion a year -- not terribly surprising when you consider that more than a third of American adults are obese.

That number, from 2009, is the latest reported by the CDC. Other estimates are even higher, and those costs are expected to rise.

And yet, less than 1% of that $150 billion goes toward prescription medications approved to treat obesity. Although the highly anticipated approval of two newer anti-obesity drugs, Belviq and Qsymia, has bumped up sales, neither is anywhere close to a blockbuster.

In 2013, U.S. sales of anti-obesity drugs totaled about $114 million, according to IMS Health, an international information, services, and technology company. By comparison, U.S. sales of drugs to treat diabetes, one type of which is linked to obesity, totaled about $22 billion.

Obesity experts blame lackluster sales of the drugs on several things: doctors’ lack of training in how to treat obesity, concerns about the medications’ safety, and a lack of insurance coverage.

“We still as a society believe that the things that work for preventing obesity are going to work for treatment,” says Steven Smith, MD, president of The Obesity Society, a scientific organization. “We have this inherent belief that willpower’s going to help with these kinds of issues.” But, Smith says, diet and exercise alone “by and large are ineffective for treating obesity.”

Most obese people need the help of anti-obesity medication, yet few are getting prescriptions for them, Smith says. Doctors are more likely to advise obese patients to eat less and move more or, at the other end of the spectrum, refer them for weight-loss surgery than prescribe medication, he says. Smith is the founding scientific director of the Translational Research Institute for Metabolism and Diabetes at Florida Hospital in Orlando.

“The gap in the middle is clear,” says Smith, who was involved in all phases of clinical trials of Belviq, the newest anti-obesity medication on the U.S. market. He spoke on behalf of its manufacturer, Arena Pharmaceuticals, at an FDA advisory committee meeting on the drug. “We are not educating physicians about how to manage obesity in a busy clinical practice.”

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