Employers must get off the sidelines in the obesity fight

Coverage of obesity treatments will become a recruitment and retention tool for workers in a competitive hiring market.

Obesity is a burgeoning challenge for employer health plans. It's been around for decades but mainly ignored by insurers and health plans largely due to a lack of effective treatments and the societal stigma that it's the patient's fault. The medical community didn't even declare obesity as a disease until 2013 so as a society we are just figuring out that it is indeed a medical condition. Stigma is a powerful thing, but math and science must win the day. We must move from blame to biology in order to make real progress.

The stereotypes for weight bias are well known even if not internally recognized as they happen. We perceive the person as lazy, slow, unintelligent, incompetent and lacking willpower. We are reluctant to hire them and quicker to let them go than normal weight peers. However, math and common sense tells us to rethink this flawed equation.

Over 123 million people in the US have obesity. (Note even Microsoft's grammar check tried to turn "have obesity" into "are obese" which perpetuates the stigma that the person is the disease versus has the disease. It's a subtle but important distinction.) Is it possible that over 40% of the adult population are truly slow, lazy and unintelligent? I realize that this is an election year and some of you may feel that way about the other political party, but obesity crosses party lines.

Most people with obesity know they are overweight. They have tried and failed at countless diets and exercise plans. Even the US Military's exercise regimen only resulted in a 1% average loss of body weight in a recent report on the impact of obesity on our military readiness. Diet and exercise alone simply don't work for most people in the long term. The body is a resilient and stubborn marvel of biology that fights hard to maintain its highest weight set point. Losing weight makes it fight even harder to get it back and dieters often regain more weight than they originally lost. A depressing fact for those of us who are fighting obesity.

Speaking of depressing, obesity is killing Americans at an alarming rate. It is second only to smoking as the most preventable cause of death in this country. One in 5 deaths of black and white Americans aged 40 to 85 years is attributable to obesity. It shortens our life spans especially when developed at a younger age. Black men aged 29-30 with extreme obesity are projected to lose over 11 life years due to the disease. Their white counterparts of the same age are projected to lose more than 8 years.

Blaming and shaming worked for the anti-smoking campaign, but it backfires with obesity as one of the most common coping mechanisms for stress is overeating. Case in point, it is well known that many people who quit smoking gained weight over the course of beating their nicotine addiction.

So here we have a very devious and deadly foe in obesity. We're predisposed by our biases to not want to fight it at all, and we don't really comprehend what it's costing us to sit on the sidelines. The cost of obesity is just beginning to be studied. (No offense intended to the health economists out there who are doing some great work in this area.) Obesity is linked to 200 medical conditions. Please read that again and let it sink in as you consider why our health costs are rising so quickly. Notably it is linked to type 2 diabetes, cardiovascular disease, stroke, 40% of all cancers, kidney disease, Alzheimer disease and nonalcoholic liver disease among literally dozens of others.

Cost studies to date are hampered by a lack of formal diagnosis in medical charts caused in part by a combination of medical stigma paired with economic reality "why diagnose something that isn't covered by insurance?" We understand the cost of the comorbidities but haven't connected the dots upstream. The dots are big and getting bigger.

The introduction of GLP-1s onto the medical scene has been the most promising sign of hope in our fight against obesity since the development of bariatric surgery. We now have non-invasive treatments that provide significant weight reduction for many patients, but these new drugs are expensive. Can we afford to cover them in our health plans? Can we afford not to cover them? One of the GLP-1's on the market has been shown to significantly reduce the odds of a heart attack, stroke or cardiac death. Another essentially eliminates the risk of developing type 2 diabetes. Those are truly amazing value propositions. It is reasonable to expect reductions in other comorbidities will be shown by future studies as they are completed.

When looking at the cost of these new medications we need to remember the stark difference between list prices and net prices after pharmacy benefit manager driven rebates. The rebates and discounts on GLP-1s for obesity are estimated at 41% making the monthly cost a health plan actually pays around $750 versus nearly $1300. That is still a high number but far less than the headlines report and what many consider in their cost estimates.

The current estimate of the annual medical cost of a person with obesity is $12,588. That is 2.7 times higher than a normal weight member of a health plan. When you factor in the higher incidence of absenteeism, presenteeism and disability the annual cost per person balloons to $17,544. Can we really afford to stay on the sidelines and blame our employees?

Health plans need to review their coverage of all viable methods of treating obesity. GLP-1's are more effective when combined with lifestyle changes. Are we covering intensive behavioral therapy (IBT)? Are we covering medical nutrition therapy (MNT)? Most employers will happily support smoking cessation classes for anyone who wants them. Why aren't we doing the same thing with obesity? These therapies are inexpensive and far cheaper than bariatric surgery.

Many plans follow Medicare's outdated rules that IBT and MNT must be delivered in a primary care setting. That is absurd. These services don't exist in primary care offices. We need to remove the barriers to accessing IBT and MNT from our plans immediately. You can't break generational habits without education. (To highlight the importance of education, people with a college degree are 35% less likely to develop obesity than those with only a high school diploma.) IBT and MNT are the least costly investments in employee health you can make.

In closing, we must remind ourselves that obesity is a metabolic disease driven by genetics and the environment. It is no one's fault. Obesity is a public health crisis that is clearly driving our escalating health care costs. Working age Americans have the highest BMIs than any other age group making this an employer issue. Obesity impacts our minority populations disproportionately compounding the effects of social determinants of health which also need to be on our radar. Black Americans are 20% more likely to have obesity than their white counterparts. Hispanic Americans are 10% more likely.

We have powerful treatment options today and more are on the horizon. It is clear from consumer demand that people want to get better. They want to lose weight and gain the health benefits and improved quality of life that comes with it. Employers can't afford to stay on the sidelines in this fight any longer. Coverage of obesity treatments will become a recruitment and retention tool for workers in a competitive hiring market. It will improve morale and the bottom line. It will also reshape the health of this country.