Obesity in America is a significant health concern with important implications for individuals, employers, providers, and the healthcare system at large. Health plan sponsors have a vested interest in supporting plan members in their weight management journeys, not only because it promotes a healthier workforce, but also because it takes steps to reduce the growing economic burden associated with obesity-related conditions.
Here we discuss the value of a whole health approach to weight loss in the treatment of obesity – one that integrates strategies around multiple aspects of a successful, safe, and cost-effective weight management program. These aspects include behavioral health, diabetes and other co-morbidities, personalized treatment plans, evidence-based clinical rules for GLP-1 use, and outcomes that can help reduce the cost of care.
Overview: Obesity in the U.S.
America is wrestling with a weight problem. It's alarming: The CDC points out that the rate of obesity has tripled over the past six decades. Today, 42% of us are, medically speaking, obese,1 and the consequences are no small matter.
Conditions like heart disease, stroke, type 2 diabetes, certain cancers – all linked to obesity – are causes of serious, sometimes life-threatening, illness. Type 2 diabetes already affects 14% of the U.S. adult population,2 and it’s estimated another 84 million are at risk of developing it,3 presenting a call to action for addressing weight loss treatment as a means of prevention.
42% of adults $173 billion
prevelence of obesity in the U.S.1 annual related medical costs in U.S.4
These health problems bring with them a hefty price tag. The annual medical cost related to obesity in the U.S. has rocketed to $173 billion, with research revealing more than $1800 higher medical costs annually for adults with obesity than for those with healthy weight.4 Add the highest-ever federal spend on obesity research of $1.2 billion last year,5 and it's clear that this is a situation the nation can't afford to ignore.
Certainly, people care about their weight, and employers care about their people. Recent studies show that more than 49% of U.S. adults have tried to shed pounds in the past year,6 and there is ever-increasing public interest in trying prescription medications like semaglatude (also known as GLP-1s) for weight loss. 45% of American adults are reportedly interested,7 despite potential risks identified by the Food and Drug Administration (FDA) Adverse Event Reporting System, such as hair loss and suicidal ideation, and known common side effects such as nausea, vomiting and headaches.8
Common approaches to weight management: What works and what doesn't?
Safe and lasting weight management is a journey unique to every individual, giving rise to the countless methods and options considered to combat overweight and obesity in America. These methods range from do-it-yourself weight loss plans, to holistic behavioral health and lifestyle changes, to surgery or popular weight loss drugs. Let’s take a look at these common approaches and consider their potential outcomes.
Self-managed weight loss attempts
For most people, losing weight and keeping it off is not easy – especially when managing diet choices and exercise schedules independently. And yet, more than 160 million Americans are on a diet at any given time, spending more than $70 billion each year on commercial weight-loss plans, supplements and related.9
These self-managed attempts at diet and exercise tend to bring initial results, but frequently, the lost weight is regained within months, due to challenges such as a strict regimen of denial, unappealing food choices, or time commitments to physical activity. Indeed, 65% of U.S. adults believe that willpower alone is usually not enough to lose weight and keep it off.10 Obesity treatment often benefits from a more sustainable strategy aligned with health status, clinical evidence, and program goals, instead of relying on individual efforts alone.
Lifestyle and behavioral modifications
Lifestyle and behavioral modifications form a valuable cornerstone of weight management. Published clinical guidelines advocate for these modifications as part of the initial treatment for obesity, along with other tactics such as education on nutrition and physical activity.11
Or, when initial treatment plans are unsuccessful, medication-assisted weight loss in conjunction with behavioral therapy can help meet goals for clinical outcomes. This demonstrates how a whole health approach provides a set of keys to unlock the potential for long-term, holistic results. Those keys may include a connected provider team, a health-first mindset, progress tracking, and behavioral health care that continues even after weight loss goals are met, to support lifestyle wellness and ongoing weight maintenance.
Prescription medications and surgery
Medications are another tool that may be used to support those managing obesity. Some drugs, such as phentermine, are intended for short-term use to jump-start weight loss with appetite control, and newer GLP-1s medications also assist in weight loss.
These popular GLP-1 drugs can result in significant weight reduction in conjunction with lifestyle, diet, and exercise changes. However, several concerns remain, including side effects and adherence. One study found that a full 30% of patients stopped treatment within four weeks before even reaching the targeted dose, and many people discontinued use of GLP-1 therapy before achieving clinically meaningful weight loss.12 Studies are ongoing to determine the long-term impact of GLP1s used specifically for weight loss. Due to their high price tag, health plan sponsors naturally have concerns about appropriately managing costs in relation to the outcomes experienced by their members.
Some individuals with severe obesity may consider surgery as an option. Bariatric surgeries include both reversible and permanent procedures to limit food intake physically, but surgery alone does not target the kind of behavioral and societal health influences that help ensure success in maintaining weight loss.13 Insurance coverage for these surgeries and medications varies by state laws, employer's health plans, and individual patient evaluation.
We see that successful weight management isn't a one-size-fits-all formula; rather, it involves an evidence-based, individualized, multi-faceted approach for lasting results. And today, a topic of much discussion is if and when GLP1s should be leveraged to support weight loss efforts in light of exploding consumer demand.
Weight loss, GLP-1s, and impacts on employers' pharmacy benefits
As mentioned, while GLP-1s were originally introduced for type 2 diabetes, newer drugs have been introduced that treat obesity and support weight loss. The increasing reliance on GLP-1s for weight management presents both opportunities and challenges where employers and pharmacy benefits are concerned.
Employers are considering GLP-1 coverage for weight loss as another way to support the health and well-being of their workforce, which brings with it potential gains in employee satisfaction, productivity, and more. Among human resources leaders, GLP-1 coverage is seen as a desired benefit – in fact, 81% feel their employees are interested in GLP-1 coverage, and 77% agree that coverage will make employees feel they have a stronger health insurance package.14
Leveraging these medications, however, introduces concerns around cost and appropriate use.
In closing: CarelonRx perspectives
The impact of obesity on health and wellness, and the economic burden it brings with it, make it a pressing issue for health plan sponsors and their plan members. The role of GLP-1s for weight management is being considered as an industry influence on pharmacy benefits design, utilization, and cost management.
Strategy & Savings: We know that shaping pharmacy benefits with the right strategies in place – like ensuring clinically appropriate, evidence-based use of GLP-1s with rigor around prior authorization – can help keep healthcare costs in check. And when it comes to treating obesity, a condition that requires long-term management, the savings are vital for employer plan sponsorship and pharmacy benefits.
Engagement & Outcomes: In addition to clinical rules application, lifestyle and behavioral modifications are another bedrock of sustainable weight management outcomes. When members engage, they learn fundamental changes in diet, exercise, and mindset that have lasting impacts on their health. Embracing these changes from the start gives them control over their weight loss journey, empowering them to make healthier choices that can help prevent other related health events and conditions.
Safety & Support: While GLP-1s may work for many when results are monitored and use is appropriately managed, the significant value of psychosocial support throughout a weight loss journey should not be overlooked. It's also crucial to provide support for members being treated with GLP-1s for weight loss who are seeking to wean off these medications. Controlled transition off drug therapy to natural weight management methods helps mitigate weight regain, so members can enjoy the ongoing rewards of maintaining their body weight and reaching their health goals.
Additionally, providing the member with the resources needed to sustain their enhanced lifestyle is another key factor in their success. This includes not only the nutritional aspects, but behavioral and mental health support, as well – key advantages brought to the treatment plan by a whole health approach.
Employers and health plan sponsors play an important role in addressing these concerns due to the level of influence they can have on their employees' health behaviors and healthcare resources.
CarelonRx recommends providing support and advocacy over the course of each member’s journey, including the digitally focused weight management program CarelonRx recently introduced into market for those challenged with an obesity diagnosis. The program is supported by CarelonRx’s deep clinical oversight, including formulary and prior authorization strategies to ensure clinically appropriate use of GLP-1 medications. This integrative approach provides reassurance for employers and plan sponsors as they address the ongoing use and impact of GLP-1s.
And it is this kind of integrative approach to weight management that fosters true whole health benefits.
References
1 Centers for Disease Control and Prevention [CDC]: National Center for Health Statistics [NCHS] Data Brief No. 360, February 2020: cdc.gov
2 Centers for Centers for Disease Control and Prevention [CDC]: National Diabetes Statistics Report (accessed August 2024): cdc.gov
3 Alvarez S, Coffey R, Mathias PM, et al: Prediabetes (Updated July 2023): StatPearls (accessed August 2024): ncbi.nlm.nih.gov
4 Centers for Centers for Disease Control and Prevention (CDC): Adult Obesity Facts (accessed August 2024): cdc.gov
5 National Institutes of Health (NIH): RePORT: Estimates of Funding for Various Research, Condition, and Disease Categories (RCDC), May 2024: report.nih.gov
6 Centers for Centers for Disease Control and Prevention (CDC): National Center for Health Statistics (NCHS) Data Brief No. 313, July 2018: cdc.gov
7 KFF: Poll: Nearly Half of Adults Would Be Interested in Prescription Weight-Loss Drugs, But Enthusiasm Fades Based on Lack of Coverage and Risk of Regaining Weight, August 2023: kff.org
8 U.S. Food and Drug Administration: July - September 2023 | Potential Signals of Serious Risks/New Safety Information Identified by the FDA Adverse Event Reporting System (FAERS): fda.gov
9 Harvard Health Publishing: Diet and Weightloss (accessed August 2024): health.harvard.edu
10 Pew Research Center: How Americans View Weight-Loss Drugs and Their Potential Impact on Obesity in the U.S., February 2024: pewresearch.org
11 American Journal of Managed Care (AJMC): A Review of Current Guidelines for the Treatment of Obesity, December 2022: ajmc.com
12 Blue Cross Blue Sheild: Real-World Trends in GLP-1 Treatment Persistence and Prescribing for Weight Management, May 2024: bcbs.com
13 Surgery for Obesity and Related Diseases: Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures – 2019 update: soard.org
14 Accolade: GLP-1 Coverage in Employer Plans Could Nearly Double in 2024, October 2023: ir.accolade.com
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