Why do we continue to punish obese people?

If you didn’t know the statistics were for obesity and saw there was a condition affecting over 100 million Americans that led to direct medical care costs over $289 billion and indirect costs were over $15 billion annually – you’d assume we were talking about a major chronic condition. 

But to learn that less than 5% of members actually seek medical treatment due to limited coverage through their employer-sponsored health plans – you’d call it a crisis. 

‍But we are talking about obesity, which continues to be thought of as a lifestyle condition that can simply be reversed with proper nutrition and physical activity. A condition that despite the multitude of wellness options and vendors, physical activity for every interest, and a healthy and organic food section in practically every grocery across the country, obesity rates continue to rise year after year. It’s time. 

It’s time to realize and come to terms that our opinions and treatment for obesity are outdated and it needs to change. 

Obesity is a chronic condition. It’s also a significant factor in other conditions like:

• Diabetes
• Heart disease
• Musculoskeletal disorders 
• Gastrointestinal disorders
• Cancer

All of these conditions are clinically accepted and treated with various medical and pharmacy options for severity and disease progression – yet less than 25% of employer plans offer prescription drug coverage for weight loss.

You may be thinking that’s unbelievable - there is no magic pill, and making lifestyle changes is the best way to treat obesity. 

‍I’m a Registered Dietician and can confidently say that in my 20+ years of practice, things have changed that make weight loss more and more challenging for everyone to the point where traditional diet and exercise may simply not be enough. 

Certainly, diet and exercise is a foundational factor, but we must also consider everything working against us – stress, hormone dysregulation, and environmental factors like endocrine disruptors, chemical exposure, and poor food quality. 

Addressing Obesity as a Prevalent Chronic Condition

Employers are looking for every way possible to support their employees and families. Over the past several years, they have continued to expand and offer a wide range of ancillary benefits, including a strong focus on family-forming benefits that provide accessibility to treatments like IVI/IVF, surrogacy, and egg/sperm freezing. These programs can be life-changing and create wonderful success stories but are often not put in place to save healthcare dollars or cut costs. 

Why are we okay with spending in one area and shutting out another condition?

Now, it’s evident that giving full access to obesity medication could easily blow up any employer plan, even if only half of the qualifying participants started taking them. Below are ways to develop a thoughtful and strategic approach to addressing one of your most prevalent chronic conditions, obesity: 

Develop a Multifaceted Program for Obesity

• Require enrollment in lifestyle management/coaching program
• Provide access to weight loss drugs (i.e., GLP-1’s) at reduced out-of-pocket cost to members
• Require participants to remain engaged and show outcomes (i.e., completing lifestyle courses, meeting with coaches, weight loss, improved biomarkers)
• For long-term programs, continue to offer access to lifestyle programs and prescriptions at a discounted cost but require ongoing achievement of biomarkers and weight maintenance

Utilize Non-brand Name GLP-1s

• Explore options to partner with compounding pharmacies and providers with experience working with and prescribing peptide therapy
• Ensure the correct form of semaglutide is utilized for safety issues
• Include coverage of semaglutide for a fraction of the brand name price

Add a Specialty Rx Carve-out

• Include GLP-1’s on your list of carve-out medications, members can then use a patient assistance program to obtain the drug

Require Prior Authorization to Assure Individuals Using GLP-1s Meet Designated BMI Criteria

• Reserve use for diabetes and obesity
• Limit use to those who are looking for short-term use 

Now is the Opportunity to Try a New Approach

To date, most employers have attempted to tackle obesity with general wellness programs. Wellness programs are useful and have their place in overall benefit programs, but we know the long-term success rates haven’t been proven.

Behavior change isn’t enough; we need a total solution that incorporates lifestyle and support mechanisms that include medical and pharmacy interventions. 

If we continue to focus on a one-dimensional approach and shut out non-traditional therapy, I can guarantee one thing – obesity rates will continue to rise. And with it, the cost to employers, employees, and health plans will only suffer more.