8 ways to use behavioral science to address obesity

Employers are enthusiastic that effective new drugs to address obesity are now available but are distraught by their exceptionally high-cost impact. The GLP-1 class of obesity medicines can lead to 15% to 20% body weight loss, which can dramatically decrease health risks. However, Wegovy (semaglutide) and Mounjaro (tirzepatide) retail for over $16,000 and cost employers close to $10,000 annually even after discounts and rebates. Facing rising costs, employers are re-examining their strategies to support employees to address obesity and cardiometabolic syndrome.

Providing support to employees in this area can be challenging, as obesity is influenced by many factors. Obese individuals rarely lose more than 6% of their weight without medical or surgical intervention. Bariatric surgery is expensive and has been performed on less than 1% of those who are obese. Semaglutide and tirzepatide are highly effective but are currently only covered by 38% of employers. Three quarters (74%) of employers that provide GLP-1 coverage have, or are considering, access restrictions such as raised BMI thresholds, coverage or treatment limits or requiring step therapy with behavioral modification programs.

Lifestyle modifications alone to control obesity have historically been ineffective at the population level. Despite that, there are a range of lifestyle modification programs of varying efficacy being sold to employers and directly to consumers. Employers are faced with unappealing choices: continue to promote lower-cost lifestyle interventions that are of minimal efficacy, allow generous but costly coverage for GLP-1s for obesity, or combine lifestyle programs with GLP-1s with an unknown impact on total cost.

Choosing a sound lifestyle management program to offer to employees and promoting it effectively to employees can be one lever to manage obesity within an employee population. One recent study showed that those who engaged in a vigorous in-person and virtual exercise program regained less weight after discontinuing a GLP-1 medication. Another study showed that adherence to a low carbohydrate diet was associated with success at avoiding weight regain after stopping GLP-1 medications.

Intuitively, it is appealing to pair lifestyle modification programs with GLP-1s, or to offer them as part of a broader wellbeing program. But for employers to invest in them, they need to be effective. This article identifies elements of effective lifestyle modification programs. Employers that want to offer obesity lifestyle modification programs can choose programs that use behavioral science precepts to increase engagement and effectiveness.

1. Make it easy to participate in a lifestyle management program and sustain healthier behaviors.

Employers can use choice architecture to make participating in lifestyle modification programs easy for plan members. They can offer a program with multiple modalities for coaching and clinical care for member convenience. Lifestyle programs that are integrated with other chronic disease programs already in place can be more convenient for members with multiple conditions. Employers can increase engagement by using “call-to-action” messaging and attain higher enrollment by offering click-to-access functionality such as QR codes.

Employers can also make it easy for their employees to eat well by investing in healthy vending machines or cafeteria options or offering coupons for a healthy meal delivery service. Time set aside for meals or walking clubs that are easy to fit into schedules may support overall health. Fitness stipends, gym discounts, or technology to track steps and activity to promote physical fitness are opportunities for employers to make it easy for employees to have healthier lifestyles.​

2. Harness intrinsic motivation.

Focus attention on the goals of plan members, as intrinsic motivation is a powerful driver for behavior. Demonstrate that getting support through employer-sponsored programs can help members to achieve their own goals​. Employers should avoid programs or communications with negative or shame-evoking language, and programs should promote bodily autonomy and respect individual decision-making. Coaches can help people discover and reinforce their personal motivations for managing their weight​, and programs can allow members to design their own care plan and goals in partnership with a coach or clinician.

3. Promote healthy behaviors through social networks.

Employers can positively encourage participation in lifestyle management programs by using social networks. Internal communications can tell stories of volunteer colleagues who have gained benefits from lifestyle management programs and leverage social media to share the program’s goals and accomplishments more broadly​. Further, employers can leverage trusted existing networks such as Employee Resource Groups to promote wellbeing initiatives, and recruit wellbeing champions to spread the word and foster a sense of community​.

4. Recognize that employees overestimate their ability to overcome obstacles.

We human beings have optimism bias and overestimate our ability to “tough it out” and reach goals without support. Communications can direct members to appropriate support and resources to improve likelihood of success in managing weight. Avoid messages that make people feel disheartened, remembering that many employees and family members with BMIs of over 25 are active, exercise regularly and feel good, and sustainably losing large amounts of weight is difficult without medical or surgical therapy.

To support those participating in programs, set achievable ​goals that don’t undermine ​optimism, and deliver encouraging messages on accomplishments and milestones for both program participation and weight loss achievement​.

5. Use narrative to convey the positive impact of lifestyle changes.

Powerful stories drive more behavior change than impressive statistics​. Employers can reach the widest audience by telling stories from employees who took different journeys to successfully making lifestyle changes ​and encouraging vendors to use narratives as well. Testimonials can be delivered through multimedia channels such as brief quotes on the intranet, emails and flyers​, and asking employees to share success stories in webinars, town halls or lunch & learn settings.

6. Encourage action through framing.

Since people tend to consider options in context, employers can frame the use of employer-sponsored programs or solutions as easier than employees tackling the issue on their own. To encourage participation, portray lifestyle modification efforts as easier than dealing with chronic conditions, including the time and cost associated with medications and complications. Communications can include focus on small but highly achievable lifestyle changes that can have a large impact over time such as swapping water for soda.

7. Leverage “present bias” to spur action.

People are more focused on the present and discount what will happen in the future when making decisions. This is especially salient in lifestyle management as improved health in the future requires consistent nutrition and activity choices in the present. This bias can be a significant challenge as benefits from positive choices may take time to come to fruition, but there are opportunities to use present bias to nudge behavior.

Employers should look for solutions that focus on short-term wins. For example, people feel much better after even a small amount of weight loss that can be achieved in a few weeks. Programs should encourage healthy eating that tastes good and makes people feel energized right now, and encourage exercise that people enjoy in the moment.

8. Implement initiatives that are perceived as fair.

Individuals are sensitive to perceived fairness, and are less likely to embrace programs or incentives they perceive as unfair. Programs that feel unfair can be demotivating to employees. BMI and other goals can vary depending on gender, race, ethnicity, muscle mass and starting point. Accordingly, avoid incentives based on Body Mass Index (BMI), which have not been shown to drive sustainable weight loss and can be perceived as unfair. In communications, emphasize that everyone deserves to live a full and healthy life regardless of body type, background, or circumstances.

Employers can also utilize fairness by connecting healthy activities that allow everyone to start at different points of health, with options on how to participate in challenges such as being able to choose type and intensity of exercise depending on physical ability.

Related: Employer’s guide to navigating weight-loss medication coverage as market soars

Conclusion

Effectively supporting employees to manage obesity is a significant challenge for employers, as the condition is complex and costly to treat. Behavioral science offers evidence-based strategies to drive higher engagement in employer-sponsored lifestyle management programs and cultivate intrinsic motivation for healthy behaviors.

By making programs easy to access, leveraging social influence, focusing on immediate benefits, using relatable narratives, ensuring fairness, and harnessing present bias, employers can better set up their employees for success in achieving sustainable weight loss and management. Lifestyle interventions alone have limited long-term efficacy, so many members will need effective medical or surgical therapy to attain optimal healthy weight.

Jessica H. Jones, MA, is an Associate Director in the Health, Equity and Wellbeing practice in WTW’s Health and Benefits business, with over a decade of experience in consulting and health care management.

Jeff Levin-Scherz, MD, MBA, is a Managing Director and Population Health Leader of the North American Health and Benefits practice at WTW. He is an assistant professor at Harvard Medical School and the Harvard TH Chan School of Public Health.

Julie Noblick, MPH, is a Director in WTW’s Communication and Change Management practice. Prior to joining WTW, Julie worked domestically and abroad on a range of public health issues for the government and not-for-profit sectors.