The challenges employers face

According to Sarah Wells Kocsis, director of public health at the Milken Institute, obesity is now understood to be a chronic condition with many different root causes. This means that treatment for obesity has to be personalized, which can pose a significant challenge.

"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."

Lifestyle changes like dieting and exercise can work for some people, but that's not always the case for everyone. Some patients may need bariatric surgery or medication alongside their lifestyle changes.

However, while GLP-1 weight-loss drugs have been proven to be highly effective in weight loss, they're also very expensive. For example, Wegovy costs employers between $9,000 and $10,000 per patient per year after discounts and rebates, according to WTW.

While it's possible the cost of GLP-1s could pay off in the long run by reducing hospital visits and the costs of other conditions like diabetes, it's too early to tell, and the data can be difficult to gather, Plescia reports.

"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.

Gremminger added that some people start on GLP-1s and then stop taking them soon after, which adds to the difficulty of gathering data. According to Mark Cunningham-Hill, chief medical director of Northeast Business Group on Health, it's possible that some people will have to take GLP-1s for life, since many patients regain most of their weight after going off the drug, which would further increase costs for employers.

It's also important that patients incorporate lifestyle changes while taking the drugs. "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.

What employers can do

While the challenges can be difficult, obesity is something employers need to address, according to Wells Kocsis.

"The time is now. … This is an epidemic that we must tackle now. [Obesity] is affecting so many aspects of our community," she said. "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 Milken Institute issued a recent report providing employers with a variety of actions they can take to improve obesity care for their employees.

Some potential actions include creating platforms for employees to easily access the most recent research about obesity, collaborating with education and advocacy groups, providing employees with flexibility to attend medical appointments, contracting with vetted obesity management specialists, and paying attention to federal legislation.

The report also recommends applying the Obesity Bill of Rights, which was developed by the National Consumers League and National Council on Aging and states that people with obesity have the right to accurate and accessible information, as well as financial coverage for treatment and the freedom to make treatment decisions.

However, the most important thing employers can do is take a comprehensive approach to obesity and provide a variety of options, Wells Kocsis 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."

Advisory Board's Rachael Peroutky also emphasized the importance of employers providing comprehensive obesity care. "The good news is, in this instance, what's best for the employer is likely what's best for the patient," she said.

"Providing access to GLP-1s alone, without wrap around obesity services, is likely not the answer," she said. "Employers who package GLP-1 access within a comprehensive obesity service offering can mitigate wasteful drug spending and provide better outcomes for their employees."

Regarding GLP-1s, the National Alliance of Healthcare Purchaser Coalitions recommends that employers stay up to date on the latest science and recommends against employers only covering the drugs for a certain period of time or until they've hit a certain dollar limit.

"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 tie GLP-1 coverage to participation in a weight-management program, since the drugs are intended to be used alongside lifestyle changes. Kelsay also said it's important for employers to cover multiple weight-loss medications instead of just GLP-1s.

"While employers can make a difference, they can't do it alone," Peroutky said. "Joint investment is a necessity. Employer coverage for obesity services will only yield results if providers can also improve delivery of services."

Advisory Board's weight-related resources

To help you address the growing use of weight management drugs, Advisory Board offers several resources:

This expert insight outlines the five biggest questions about weight management drugs and their answers. Similarly, this expert insight addresses what headlines get wrong about weight management drugs and what healthcare leaders should know instead.

Radio Advisory's Rachel Woods has also covered GLP-1 drugs on the podcast, discussing the potential future of these drugs and how they could help — or hurt — health systems' finances. Other useful resources include this expert insight on the five catalysts that will impact the future of obesity care and this research on three potential pathways for the future of obesity care.

Our weight management and obesity care resource library can also help leaders understand the current care landscape, manage innovations, and prepare for transformations in care. (Plescia, MedCity News, 5/19)