Americans are gaining weight, but should employers pay the price?

Americans are putting on weight, and employers are paying the price. In addition to the physical toll on worker health, obesity contributes to reduced productivity, increased absenteeism and soaring health-care costs.

“We know that individuals who live with obesity also live with diabetes, prediabetes, anxiety, depression and hypertension,” said Tara Sherman, mental health and wellbeing strategy leader for The Boeing Co. “We partnered with our major health plan to look at the financial impact of obesity, and we found that individuals diagnosed with obesity have double the health-care costs of non-obese members. When we looked at musculoskeletal conditions, it was nearly triple the cost.”

Sherman participated in “Obesity: The Employer Conundrum,” a recent webinar sponsored by the Midwest Business Group on Health. Just as the pandemic shined a light on mental health in the workplace, the obesity problem is beginning to emerge from the shadows.

“No one knows if you have diabetes,” she said. “No one knows if you have hypertension. But living with obesity is obvious to everyone, and the judgments are more pervasive – 40% of our population is obese. There is a stigma, and what I hope is that all of the work we have poured into working on mental health over the past several years we can pour into working on obesity.“

However, understanding the problem and managing it are two different things.

“Obesity and diabetes are so hard for employers to get a handle on for a couple of reasons,” Sherman said. “One is the massive numbers we are looking at and the other is the complexity and how many contributing factors there are. The obesity diagnosis tends to be widely underreported in health claims. We believe somewhere between 32% and 42% of our population is dealing with obesity.”

Employers play a vital role in addressing these issues, said Dr. Mary Jacobson, chief medical officer for Hello Alpha.

“We have to deal with the myths and stigma around obesity to get the C-suite on board,” she said. “If you can’t get past that, nothing else is going to matter. You have an opportunity to make a huge change with your employees. You want to get ahead of the narrative and hit the problem head-on. We are at a great point with respect to all of the advances we have made to treat obesity. Don’t follow social media — follow the science.”

Related: Can we afford not to pay for obesity care?

Science has led to promising new medications called GLP-1s, such as Ozempic and Wegovy, which have been used to treat diabetes and now are being used to treat obesity and excess weight. However, the results come at a high cost, with injections costing upwards of $1,600 a month. Many employers are weighing the potential benefits against the cost to their bottom line.

“What I hear again and again is, `we’re building our strategy. We’re trying to figure this out,’” said Dr. Peter Antall, chief medical officer for Lark Health. “GLP-1s are powerful tools — but they are very expensive tools. It’s reasonable to take an approach where you look at the clinical recommendations and balance those with affordability and the financial ramifications and build your strategy. But let’s not forget that not everyone needs to be on these medications. There is a pyramid. Let’s think about the bottom couple of rows of the pyramid and what we can do for them. There are options. It’s not binary, just GLP-1 or nothing.”

Dr. Richard Frank, chief medical officer for Vida Health, agrees with this approach.

“Employers have to evaluate what they are willing to do financially,” he said. “Once the employer has grappled with the potential expense of treating this as a disease, part of it becomes, `what are the goals and how can we bring to bear specialized solutions that can work with our employees and dependents to resolve this?

“I would simply argue that as you listen to the science, having a partner that can offer a comprehensive solution is one way to attack the problem. Let’s start with low-cost interventions and make sure the right patients get the right care at the right time.”

Part of the solution may be to offer affordable benefits that promote better health but not necessarily maximum weight loss. Research shows that weight loss as little as 5% of a person’s total body weight can have a clinically meaningful impact on many obesity-related comorbidities and complications, leading to health-care cost savings and improved health.

“It’s very important to have realistic goals for both employers and employees,” he said “To me, this is about managing chronic disease and risk reduction rather than simply treating to the maximum weight loss possible. It may not be the case that the employer pays for the most expensive drug. It may be the case that the employer pays for weight loss of at least 5%, normalization of biomarkers that reflect cardiovascular risk and improvement in quality of life, which tracks with increased productivity and decreased absenteeism.”

One thing is certain – the obesity epidemic is unlikely to go away anytime soon. The Centers for Disease Control and Prevention estimate that half of the U.S. population will be obese by 2030 and that the number eventually could reach 60%.

“As employers, we have such a large role to play in how we communicate to our employees, what’s included in our health plan and how we can help influence this trajectory,” Sherman said.

In this scenario, a strategy to address workplace obesity is unavoidable.

“The reality is that patients will be looking for these drugs, it will be an issue with employee retention and the price can be significant,” Frank said. “It will not be possible for employers to bury their heads in the sand.”