Obesity and Weight Management
What is Obesity?
Obesity is typically defined in the medical community as a person with a body mass index (BMI) in excess of 30. According to the CDC, obesity in the U.S. is rapidly on the rise, increasing from 30.5% in 1999-2000 to 42.4% in 2017-2018. While its prevalence may have resulted in the normalization of obesity in the general population, this overlooks the reality that obesity is a serious medical concern. With a direct negative impact on life expectancy and being a major risk factor for a wide array of diseases ranging from cardiovascular disease to cancers, obesity is a very real and tangible condition which can’t be overlooked. According to a survey of 2,000 Americans by OnePoll and Nutrisystem, “Americans have been struggling with their weight throughout the pandemic; 76% have said they’ve gained up to 16 pounds.”
Currently, tools for obesity intervention can be sorted into two primary non-surgical categories: weight loss management programs or prescription medications. The most important difference to note between these approaches, other than methodology, is the intended
Medicine or Mentality?
While both approaches demonstrate data driven and clinical results, weight-loss management programs are considered the most appropriate approach for the general population. This reality is a primary reason for the entrance of large players into the weight-loss management program market. CVS Caremark’s recent acquisition of Naturally Slim sends a clear signal to the market that not only are there clear positive results to be seen from these programs, but also that these results are replicable, scalable, and profitable. Weight management programs being adopted by employers tend to focus significantly more on behavior rather than dieting and calorie counting. Dr. Tim Church , chief medical officer of Naturally Slim describes this difference between the classic calorie counter programs and weight management programs such as Naturally Slim as “I’m not going to take away your pizza – depriving people of the foods they love doesn’t work and it’s not real life. Instead I’m going to teach you to enjoy and savor those two slices of pizza.”
Currently, the use of prescription drug intervention is only considered appropriate in patients with other conditions, such as diabetes or high cholesterol, which can create a very difficult environment for weight loss. In these cases, physicians lean towards prescription intervention
for drastic, reliable, and predictable results. Saxenda, Ozempic, and Rybelsus are the newest medications used to facilitate weight loss in
patients who suffer from certain co-morbidities. Until December 2020, treatment was only available for adults 18 and up, but the popular drug Saxenda received FDA approval for pediatric patients 12 – 17. Employers should be prepared for additional patient populations to gain approval for these medications as more studies are completed and more options hit the market.
What this Means for Employer-sponsored Plans
Weight loss drugs can be an essential tool for cost-mitigation, disease severity suppression, and life expectancy. Unfortunately for patients and plan sponsors alike, many of these drugs do not yet have generic equivalents on the market and are high in cost. While most plans exclude weight loss medications from coverage, some employers are choosing to cover these drugs as part of their standard formulary. If medications for weight loss become more accessible and less cost-prohibitive, employers could have a new and powerful tool to combat obesity in their employee population, while also driving down overall healthcare costs. Until these medications become more affordable, it is likely that employers who decide to cover obesity treatment will end up absorbing most of the costs.