‘The Time Is Now’: How Employers Can Offer Comprehensive Obesity Care

Obesity rates in the U.S. have been steadily increasing. By 2030, about half of U.S. adults will have obesity.

While the obesity crisis isn’t new, what’s new is the availability of effective though expensive drugs like GLP-1s for weight loss. As a result, employers are facing greater demands from their covered employee population to cover such treatment.

With about half of Americans getting health insurance through their job, employers are in a unique position to drive change in how obesity is treated. But the cost issue is not insignificant. Because of this, employers need to look at weight loss more holistically. A recent report from the Milken Institute advises that employers need to educate their populations and afford them various strategies for tackling obesity including personalized treatment while also offering access to medications where necessary.

“The time is now. … This is an epidemic that we must tackle now. [Obesity] is affecting so many aspects of our community,” said Sarah Wells Kocsis, director of public health at the Milken Institute, in an interview. “We need folks to be healthy and happy and thriving. I think employers can really play an important role in being a part of the solution.”

The challenges

There is a growing understanding that obesity is a chronic disease and not a cosmetic condition, according to Wells Kocsis. Obesity has many root causes that vary among individuals. That means treatment has to be personalized, but that’s easier said than done.

“We’ve made a lot of progress on awareness,” Wells Kocsis said. “I think there is recognition of obesity as a chronic disease. But I think depending on who the employer is, their size or sector, or their demographic footprint, [they’re] grappling with what the best solution is for their particular workforce. That’s really where I feel like we’re unearthing some opportunities.”

While lifestyle changes alone (like dieting and exercise) may work for some people, there is more awareness that this is not the case for everyone. Some patients may require bariatric surgery or medication in addition to lifestyle changes. 

That is where GLP-1s are coming into play. The drugs have proven to be highly effective in weight loss but come with a hefty price tag and a lot of uncertainty. For example, Wegovy costs employers between $9,000 and $10,000 per patient per year after discounts and rebates, according to WTW.

It’s possible that the cost of GLP-1s could pay off in the long run for employers by reducing hospital visits and other costly conditions like diabetes. However, it’s too early to tell, and the data is difficult to gather.

“Even when we have that data, the indication right now is that weight loss today will equal savings 5, 10, 20 years from now, by which point a lot of these folks will no longer be employed at that company. They either have retired and moved into Medicare or they move on to another company,” said Shawn Gremminger, president and CEO of the National Alliance of Healthcare Purchaser Coalitions, in an interview.

He noted that some people start GLP-1s and then soon stop taking the drugs, adding to the difficulty of gathering the data. It’s also possible that some people will have to take these drugs for life, as many regain most of their weight after going off of the drug, said Dr. Mark Cunningham-Hill, chief medical director of Northeast Business Group on Health. This would further increase costs for employers.

In addition, it’s important that the right people take the drugs and that they incorporate lifestyle changes as well.

“Too many people assume that the GLP-1s are a ‘magic bullet’ and that they can continue life as before and not make the other changes needed in their life,” Cunningham-Hill said in an email.

The solutions

While the challenges employers are facing are no joke, there are ways to mitigate them. This includes educating employees, encouraging lifestyle changes like healthy eating and exercise, and covering a broad array of medications, not just GLP-1s. 

The Milken Institute’s recent report provided several actions employers can take to improve obesity care for employees. The actions are split into four categories: education, culture change, strategic benefit design planning and public policy. They include creating platforms for employees to easily access the most current research about obesity; collaborating with education and advocacy organizations; giving employees flexibility to attend medical appointments; contracting with vetted obesity management specialists; and monitoring federal legislation.

In addition, the report recommends applying the Obesity Bill of Rights, which was created by the National Consumers League and National Council on Aging to ensure people with obesity are properly screened, diagnosed and treated. The Obesity Bill of Rights states that people with obesity have the right to accurate and accessible information, financial coverage for treatment and the freedom to make treatment decisions, among other things.

But most importantly, employers need to take a comprehensive approach to obesity and offer a variety of options, Wells Kocsis of the Milken Institute said.

“We really are in a new era of obesity care, where there are many different facets,” she said. “Now, what do I mean by that? There’s behavioral health. There are surgical options. We have new medications and therapies. It’s very important that people work with their clinicians to figure out what is the best option for the individual person.”

When it comes to GLP-1s, the National Alliance of Healthcare Purchaser Coalitions recommends staying up to date on the latest medical science. What the organization does not recommend is employers saying they will only cover GLP-1s for a certain amount of time (like a year for example), or that they will stop covering the drugs once they hit a certain dollar amount. 

“Let’s say you have an employee or their family member who’s on a GLP-1,” Gremminger said. “They’re having success, they’re losing weight, they’re getting healthy, and then suddenly they hit this number and now they’re just kicked off. That’s not an appropriate way to handle this.”

Ellen Kelsay, president and CEO of the Business Group on Health, said employers could also tie coverage of GLP-1s to participation in a weight management program, as the drugs are intended to be used with lifestyle changes. According to Mayo Clinic, recommended lifestyle changes include healthy dietary changes and increasing daily activity. Kelsay also noted that it’s important to cover multiple weight loss medications, not just GLP-1s, as these are less expensive and can also be effective. Non-GLP-1 weight loss medications include Contrave, Qsymia and Xenical.

Cunningham-Hill added that before taking medications, patients need to be educated on expectations and common side effects. Employers can also implement prior authorization requirements to make sure the right patients are using the treatments.

Why employers should make these changes

In addition to social and moral reasons, there are economic reasons as to why employers should offer comprehensive obesity treatment, according to the Milken Institute’s report. It cited a GlobalData study, which found that obesity and overweight among employees in the civilian workforce cost about $425.5 billion in 2023.

Gremminger added that employees are demanding support. About 44% of people would change jobs to get coverage for obesity treatment, according to a survey done by the Obesity Action Coalition and Ro.

“If you can help people solve one of the biggest challenges in American life, which is obesity, you’re going to end up having a happier, healthier workforce,” he said.

Photo: Peter Dazeley, Getty Images