Obesity Care Benefits: Four Questions for Plan Sponsors

Guest ContributorAugust 17, 2023October 5, 2023

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Obesity care is emerging as an employee benefits need. What should employers and plan sponsors consider when designing offerings?

While it still carries the stigma that it’s simply a lifestyle choice, obesity is a chronic disease that has reached epidemic proportions in the United States. More than 42% of Americans have obesity,¹ which has big implications for their physical and mental health. Obesity is a leading risk factor for diabetes, heart disease, stroke, high blood pressure, osteoarthritis, liver and kidney disease, mental illness, reproductive disease and many types of cancer.

Even before obesity leads to life-threatening conditions, it can impact workers in their day-to-day jobs. Insomnia, sleep apnea, fatigue, back pain (all of which can be caused by obesity) and weight-related injuries deeply affect workers—and their employers’ bottom lines. Obesity-related absenteeism costs the U.S. $8.65 billion annually,² while productivity losses cost nearly $66 billion.³

More and more job seekers are seeking access to health and wellness benefits, and obesity care is now emerging as a critical benefits need. How should forward-thinking benefits leaders prioritize this new care within their benefits offerings?

Following are four questions to consider when reviewing obesity care benefits.

1.What obesity services or medications does the plan cover?

The 2022 Employee Benefits Survey from the International Foundation of Employee Benefit Plans found that 22% of organizations cover prescription drugs for weight loss, while 45% offer benefits to cover bariatric surgery.

To ensure the best outcomes, surgery requires extensive preoperative evaluation and care,⁴ including psychological testing and counseling, identifying co-occurring conditions that may pose risks and more. Surgery costs have been rising, and many insurance carriers now require six to 12 months of a continuously medically supervised diet.⁵ This can be frustrating for people with obesity who have likely undergone years of failed diets—just without formal documentation. They may desire a solution that’s less invasive than surgery, like weight-loss drugs.

Employers and plan sponsors should review their prescription drug formularies and consider whether they want to cover antiobesity medications (AOMs).

A new development in the discussion about obesity care is the latest generation of prescription weight-loss drugs, including the generic drug semaglutide sold under the brand names Ozempic® and Wegovy®. Although these glucagon-like peptide-1 agonists (GLP-1s) have been around for a while to treat diabetes, the U.S. Food and Drug Administration (FDA) recently approved Wegovy—alongside intensive behavior support—to treat obesity. But these drugs come with a hefty price tag, ranging from approximately $730 to $1,400 for a monthly supply.⁶

Employers and plan sponsors considering covering these new weight-loss medications will need to balance the costs of rising claims for obesity-related conditions with the costs of covering these drugs. GLP-1 drugs are significantly more expensive than other AOMs such as phentermine and topiramate, which have been around for years. And, like any prescription drug, GLP-1s come with potential risks of side effects and adverse reactions, which should be closely monitored during utilization. By contracting care teams of physicians, registered dietitians, health coaches and even licensed therapists (as appropriate), employers can help mitigate those risks.

To control the costs associated with the newer AOMs, plans may wish to work with their pharmacy benefit managers (PBMs) to implement a prior authorization program inclusive of a step therapy approach as part of their benefits management strategy. That could mean requiring preauthorization before prescribing GLP-1s and offering behavior change support as the first order of treatment before stepping up to less expensive AOMs if necessary and GLP-1s as a last resort. This way, employers can better control for only about 5% of their workforce taking GLP-1s while still driving outcomes for the majority at a lower cost.

That said, new GLP-1 drugs can offer improved clinical outcomes for those who need them, including 15-20% weight loss.⁷ They have proved to be effective at lowering blood sugar levels, curbing hunger cues and increasing fullness. They can be life-changing for people who have struggled with obesity for years. They may also reduce employer and plan health care spending on obesity-related diseases and surgical interventions in addition to reducing absenteeism, increasing productivity and potentially attracting talent.

2. Does the plan offer intensive behavior change support?

The U.S. Preventive Services Task Force found that personalized behavioral support was more effective in helping people achieve weight loss than any particular diet.⁸ According to the study, people who received more than 12 sessions with a dietitian saw significantly more reductions in their rates of prediabetes and cardiovascular risk than those who received less personalized care.

Employers can subsidize in-office visits for that behavior change support. Partnering with a virtual care provider is another option. Good virtual care solutions encircle people with care teams of registered dietitians, mental health coaches and physicians to deliver the human-centered care crucial to obesity outcomes. By taking a step therapy approach, they can give nutritional guidance and mental health coaching (or cognitive behavioral therapy), then move up to medication when clinically appropriate.

Even more important than pounds lost, behavioral support can help move the needle on biomarkers that matter and prevent conditions like obesity and prediabetes from progressing to more serious—and expensive—conditions like diabetes, heart disease and more.

3. Do you offer easily accessible healthy food options?

It can be hard for people to prioritize healthy eating during the workday. More often than not, people grab what’s convenient when they are on the go. Employers can make a real difference by providing healthy and convenient food in cafeterias, break rooms and vending machines. Those with remote workforces might consider offering subscriptions to healthy meal delivery services.

Employers can encourage healthy eating and avoid singling out employees with obesity by launching a healthy eating program that includes education on the following topics.

The basics of nutrition and reading labels
Easy ingredient swaps for making favorite meals and family recipes more nutritious
Suggestions for lifestyle adjustments instead of pure restrictions

Employees can improve their health by making small changes to their eating habits and sharing their experiences as a team. By inviting discussions around nutrition often, employers can build a culture of health and community in their companies.

4. Is movement integral to company culture?

Studies suggest that exercise may be even more important to overall health than weight loss for those with obesity.⁹ People with obesity typically lower their risks of heart disease and premature death by improving fitness more than by losing weight or dieting.

Employers that want to encourage a healthier workforce can develop a positive company culture around daily movement and physical fitness. Strategies include:

Offering flexible working hours so employees have time to exercise
Encouraging employees to take one-on-one or small-team walking meetings
Providing low-cost memberships to on-site or near-site fitness centers
Launching a wellness competition that inspires employees to achieve their goals.

Compliance Considerations

When preparing to offer obesity care benefits, employers should ensure that they are in compliance with applicable laws like the Employee Retirement Income Security Act (ERISA) and the Mental Health Parity and Addiction Equity Act (MHPAEA), especially if the program incorporates a behavioral component.

Conclusion

Increasing access and removing barriers to obesity medications like GLP-1s, cardiometabolic programs, healthy eating and physical fitness are employee benefits that can promote better health and productivity. These benefits may help employers and plan sponsors save on long-term health costs and attract the best talent the nation has to offer.

Endnotes

Jason Parrott is senior vice president of enterprise growth and partnerships at Vida Health, a virtual health care and coaching platform based in San Francisco, California. He was previously senior leader of health care and well-being strategy at The Boeing Company and spent 18 years at AT&T, where he held progressive roles in human resources, focusing on mergers and acquisitions and benefits strategy. He is a former chairman of the board and current board member for the Midwest Business Group on Health.