Health Plan Design Solutions

OBESITY

Obesity is a serious chronic condition affecting 41.9% of the US adult population according to the CDC resulting in $170 billion of increased health care spending. The link between obesity and diabetes is well documented with the majority of the 96 million Americans with prediabetes (38% of the adult US population) also having obesity.

We know that a person with diabetes costs 2.3 times more than someone without the condition so preventing diabetes through weight loss aided by anti-obesity treatments and therapies is an important investment in patient health and employee productivity, which should lead to long term savings for health plans.

What can employers do today?


First, recognize that obesity is not the patient’s fault. We must remove the stigma related to obesity and type 2 diabetes and help patients successfully manage their conditions. This is a population-level problem impacted by social, economic, genetic, and environmental factors most of which are far beyond the control of an individual.

Employers can play an important role in the fight against obesity by providing access to a broad range of therapies, medicines and services appropriately aimed at those plan participants dealing with obesity.

  • Behavioral, nutritional and exercise counseling
  • Anti-obesity medications when medically appropriate
  • In extreme cases, bariatric surgery

Anti-obesity medications are a recent development in the obesity fight.  There are several effective therapies available today and several more on the near term horizon that have led to the loss of 20% or more of a patient’s body weight.  

We know from the diabetes prevention trials that the loss of just 5% of a patient’s body weight coupled with 30 minutes of exercise a day can be effective at delaying the onset of or potentially reversing type 2 diabetes in those that already have it.  

Yet many health plans are not covering these important new, innovative treatments. Most plans today will cover expensive and invasive bariatric surgery but not the counseling and drug therapies that could have avoided it.

To include anti-obesity drugs in their formulary, employers are required to opt-in. We urge employers to take this step and cover other proven therapies including counseling.