Weigh Your Options: How Can Employers Support the Management of Obesity Within Their Organizations?

Join a healthcare professional as they discuss how employers can support the management of obesity within their organizations. This is an opportunity for benefits decision-makers to learn from an obesity specialist regarding the unmet need of obesity and treatment opportunities for employees living with obesity.

The program will also explore the impact of living with obesity on employees at work, such as productivity, absenteeism, and disability, along with the outcomes on annual health spending.

Attendees will have the opportunity to ask questions at the conclusion of the program.

This program is sponsored by, and the speaker is presenting on behalf of, Lilly USA, LLC. It is being presented consistent with FDA guidelines and is not approved for continuing medical education credit.

Transcription:
Transcripts are generated using a combination of speech recognition software and human transcribers, and may contain errors. Please check the corresponding audio for the authoritative record.

AI Voice (00:14):
The landscape for weight management medications has evolved and it is important for employers to consider coverage and available solutions for healthcare benefits plans to keep up with the demand and employee needs. One of the top considerations for employers are their employee requests for coverage and how they can best support their employees' needs with the healthcare benefits they offer. As such, let's hear from an employee, Tamara, about her weight management journey and how she accessed weight management medications through her employer's healthcare benefits plan.

Tamara (00:56):
I was doing well in my work and career, but personally, behind the scenes, I was really struggling with my weight management journey. The daily grind was getting exhausting and it was taking a toll on me. I was reluctant to be part of group activities; for example, when my employer would say, "Let's take a group picture," I was hesitant and self-conscious about my weight, so I would hide in my office. I tried to lose weight through various diet, exercise, and weight management programs provided through my benefits plan. My employer offers access to gym memberships and even recently gave us access to a fitness watch, which was great. It helped me track my steps a bit and it helped me remember when to breathe. But other than that, it didn't really help me with my weight management journey. I was able to shed a few pounds initially, but then I would gain them back, so none of the plans really worked well for me. I became extremely discouraged when I couldn't make progress toward my weight loss goals with these options alone, so I decided to look into weight management medications in addition to changes to my diet and exercise.

Jae Kullar (02:21):
As employers, we need to acknowledge that obesity is a disease and fighting it may not be just a matter of willpower, discipline, or motivation for proper diet and exercise. I think losing weight is more complicated than that and may require additional support in the form of anti-obesity medications along with changes in diet and exercise, and recognize that wellness programs alone may not be sufficient to help our employees struggling with obesity.

Tamara (02:50):
I researched the options and realized through my employer's healthcare benefits plan that the medication was covered. I then talked to my doctor about different options and we came up with a plan that was right for me and I was able to get started on one of them right away.

Jae Kullar (03:10):
Employee health and satisfaction are important pillars for success as an organization. As we've received more and more requests for coverage of anti-obesity medications, we are expanding our efforts to better understand obesity as a disease along with available treatment options. Given the large cost drivers, we have organization leadership and finance teams involved in these coverage decisions. Everyone is tuned in, so we need to make a strong case for effective coverage solutions. A component of it is definitely knowing your own population and getting some of that detailed claims data and pharmacy data that we already have. It's important that employers look at the net cost—what they are truly paying versus the list price. We need to discuss changes needed to our current coverage plans based on real-world evidence, data-driven insights, and cost-benefit analysis.

Tamara (04:09):
I feel supported by my organization to be proactive about my health management goals and also valued as an employee. I understand that not all employers cover weight management medications and that many people who need these important medications may be struggling to get access to them due to lack of coverage. I believe that having access to these medications in addition to diet and exercise has helped me progress toward my health management goals. I am motivated to make the necessary lifestyle changes. This support from my employer to access the medications I need helps me feel empowered to take better charge of my health.

Jae Kullar (04:55):
Once we embark on covering anti-obesity medications for weight management, we need to analyze their utilization and evaluate how effective they actually are. As we evaluate, we should also look into other potential cost offsets. Employee satisfaction is a major factor that we should keep in mind. Let's talk and listen to our employees about other non-traditional or qualitative measurements to better assess true success as employers. Let's chart the best course for our organization to support employees with obesity. Let's define their needs, set goals, and advocate for the right coverage. We need to build the right health benefit plans, including support for anti-obesity medications in addition to lifestyle modifications. We also cannot ignore the equity element here. Not everybody can pay for these important anti-obesity medications on their own.

Tamara (05:51):
My outlook is positive. I love interacting with my colleagues and enjoy being part of group activities. I'm looking forward to a big client meeting and I'm attending a live conference in a month. Recently, my employer handed out these small bracelets that say, "Live Better." I wear this bracelet confidently as I continue along my weight management journey.

Angela Fitch (06:27):
Let me just get this going here for you. All right, so we're going to talk about "Weigh Your Options: How can employers support the management of obesity within their organizations?" I'm assuming that you all are benefits people since you're at the benefits conference, right? How many people at their current company cover anti-obesity medications currently? Just a show of hands. So it looks like maybe a third, or maybe closer to 40%—which would be what we see in the environment, right? Currently, about 48% of employers are covering anti-obesity medications, but we're going to talk about that today and why it's important to consider covering them, especially in today's world. Alright, here's the QR code that Sarah mentioned. If you want to scan that, you can get access to these slides.

Angela Fitch (07:14):
In case you want to reference them later, you can get them on your device. The program is sponsored by and presented on behalf of Lilly USA and intended for population health and benefits decision-makers. As Sarah mentioned, the goal of the program is to review information pertinent to the topic of obesity as a disease state and answer your questions about how you might be more successful at treating obesity or supporting your employees with obesity in the workplace. Alright, so we're going to start with a theoretical employee, Nicole. She's an employee you might see in your organization; she's definitely a patient that I see in my office. Nicole's engaged at work and participates in employee research groups and corporate events. She is dissatisfied with her weight and is trying to lose weight. She's committed to incorporating a reduced-calorie diet and increased physical activity into her lifestyle, and she regularly participates in wellbeing challenges.

Angela Fitch (08:03):
I think many of you probably have wellbeing challenges. Even at my own clinic, we have our little Peloton group challenge. We welcome everybody, but we're used to these types of things in our work environment. Despite her best efforts, Nicole is not seeing the results she wants and is looking for help. I really want to emphasize here today that in the 25 years that I've been doing obesity medicine, what I hear over and over is that there's a huge dichotomy between what people expect the human body to do biologically and what the human body can actually do from a weight loss standpoint as it relates to diet and exercise. This is common. You heard that from Tamara; she tried to lose weight, reduced her calories, was eating healthier, was exercising, and the weight either didn't come off or it came back.

Angela Fitch (09:42):
Employees living with obesity may also experience weight bias and stigma. You heard some of what Tamara was saying—that she felt like she had to stay in her office or was embarrassed to take pictures with her colleagues. These circumstances are embedded in our culture today around weight as a biased thing. We have to understand that it is something a lot of people don't want to talk about openly as they feel they may be being stigmatized. There is data to show hiring preference issues related to people's weight. In fact, some states have enacted laws where you explicitly cannot refuse to hire someone based on weight. But again, some of that is subversive. I have a patient who is very high up, close to the level of CEO at a very large company. He was successful and at the top of his game, and he said to me one day after losing 150 pounds, "You would not believe how people treat me differently." He never realized it before because he was already successful, but he was amazed. As a person leading an organization, it really enlightened him as to what people are experiencing because he didn't realize it until he was "different" and now people were treating him differently.

Angela Fitch (11:28):
The impact of living with obesity on employees at work is significant. There's a BMI and productivity correlation; obesity classes one through three versus normal BMI were associated with lower productivity. You can see higher costs in absenteeism, short-term disability, long-term disability, and workers' compensation claims. The comorbidities of obesity are not inconsequential. When we treat obesity as a disease, it makes a lot of other diseases better. There are over 200 other conditions associated with obesity, and when we treat the primary disease, we help treat those as well. The average annual health spending in 2021 for members of large employer plans shows that for individuals with overweight or obesity, there were 2.7 times greater costs—and this is not costs associated with treating obesity, this is extra cost in the healthcare system. We are getting tons of data now showing that treating obesity with anti-obesity medications is cost-effective. We see significant cost savings on the order of three to $4,000 a year for people who are treated for obesity. That doesn't even include the cost of medication, as that cost is so variable and there is a difference between list cost and net cost. You can search PubMed for "obesity and cost-benefit analysis" to see those articles as they get published.

Angela Fitch (14:20):
Here's a real-world example of some of the costs shown here for Indiana and New York. In Indiana, obesity led to higher absenteeism and health-related disability estimated at $901 million. For New York, it was $3.2 billion. If you look at additional healthcare spending by households, it's $712 million in Indiana and $1.8 billion in New York. To employers, it's $1.2 billion versus $3 billion. This is a hugely costly disease. The feeling now is that we can finally make a difference by understanding obesity as a chronic condition.

Angela Fitch (15:22):
In Indiana, there are close to 70,000 fewer adults able to work due to reduced labor workforce participation. I have a story of a patient who was on disability for his back. He lost 100 pounds through lifestyle modification and medication. He decided he wanted to go back to work to contribute to society and show his kids he was working. Unfortunately, he didn't consult me first; the company he chose did not have coverage for anti-obesity medications, so he lost his treatment option because he decided to go back to work. These are real-life stories of people struggling because obesity is often a carved-out benefit rather than a standard one. We are advocating for obesity to be a standard benefit like cancer or hypertension. Additionally, women with obesity earn 9% less on average. There is a serious issue with access.

Angela Fitch (18:51):
Claims data may not reflect obesity prevalence because obesity often does not appear as a diagnosis. We are working on that. As past president of the Obesity Medicine Association, we educate 5,000 clinicians on how to treat obesity and emphasize that they need to make the diagnosis. Because of bias and stigma, and frankly a bit of "moral injury," physicians often don't make the diagnosis because they feel they can't treat it if there is no coverage. We hope to work together so everyone has an unbiased understanding of the disease and access to treatment data.

Angela Fitch (19:51):
Why is Nicole struggling despite participating in wellbeing programs? Obesity is a disease driven by factors beyond an individual's control. We still struggle with the idea that "you're just not doing it right" or "just eat less." One of my psychiatrist colleagues once said, "Why don't they just sew their mouths shut?" That's ridiculous. We treat depression and anxiety with medication and lifestyle interventions; obesity is the same. The data shows that for a patient to lose 20% of their weight through lifestyle programs alone, only about 5% of people are successful. That is the science. However, with our newer medications, we are getting 40% to 60% of people into that 20% weight loss category. People want access now because the science has made the treatments better.

Angela Fitch (24:47):
The body resists weight loss by decreasing fullness and increasing hunger. This is not under your control; it happens in the hypothalamus, the same part of the brain that controls reproductive competence. Knowing that obesity is a disease, how does your organization support employees? Many offer gym memberships, wellbeing programs, or nutrition consultations. More companies traditionally cover bariatric surgery than anti-obesity medications. A survey found that 85% of large employers offered wellbeing programs in 2022. While these had positive benefits like increased exercise and engagement with primary care, they did not show a difference in actual weight or a decrease in healthcare spending.

Angela Fitch (27:26):
Multiple professional societies recommend the use of anti-obesity medications. We treat obesity comprehensively: medication, lifestyle, and potentially surgery. BMI reductions are associated with predicted decreases in costs across obesity-related complications like blood pressure, mental health, diabetes, and back pain. 80% of adults say health insurance should cover the cost of prescription weight loss drugs for those diagnosed with obesity. Historically, weight management was carved out because it was viewed as aesthetic, like a facelift. It's still stuck in that corner decades later. Currently, 48% of large employers cover branded anti-obesity medications.

Angela Fitch (30:41):
Most people need a comprehensive approach. Patients often say they don't want to be on a medication, but we have to change the conversation from "want" to "need" to achieve a certain outcome. We must also respect those who choose not to undergo treatment, just as we would with any other disease. However, with the data we have today regarding cardiovascular and kidney outcomes, it's almost reaching a point where it's vital for a physician to discuss these options. Acknowledge that employees experience weight bias and stigma, and try to decrease that in your organization. Recognize that losing weight is hard and expand coverage if possible.

Audience Member 1 (34:33):
You mentioned earlier that on average there are savings of $3,000 to $4,000 a year, but you also said we tend to put that information together without factoring in the cost because it's all over the place.

Angela Fitch (34:47):
If you take out the cost of the drug, you can see the medical savings of achieving those results. We have lower-cost medications today; not all are expensive GLP-1s. The data is variable because different companies negotiate different deals.

Audience Member 1 (35:25):
I've benefited from bariatric surgery myself and lost 150 pounds. I believe in it, but I struggle to make a business case for the ROI because of the cost.

Angela Fitch (35:46):
The data is coming. We've had shortages and COVID, but new publications using large databases are showing these benefits. Currently, because it's an employer decision, the cost burden is uneven. If coverage were mandated like cancer, the cost would be spread out. Right now, only 48% cover it, so those employers are carrying the burden. Something has to give.

Angela Fitch (38:10):
The data is looking good—roughly $4,000 in savings in the first year. Employers often worry that if people only stay for two years, they won't see the benefit. But the benefits are greater the longer an employee stays. We are seeing differences in ER visits and musculoskeletal spending within that first year. As a small company of 150 employees, we couldn't get coverage through traditional plans in Massachusetts recently. So, we created a separate benefit pool. We pay for the medication on the cash market for our employees—about $499 a month for GLP-1s, or as low as $99 for older medications. This allows employees to choose the treatment that works for them.

Audience Member 2 (43:02):
Thank you for your presentation. It's refreshing after hearing others say, "Don't cover this." We have covered branded anti-obesity medications from the get-go. This reminds me of the days when we did not cover mental health.

Angela Fitch (43:51):
Yes, that changed because we got better treatments like SSRIs. We now have a system in place to treat it, and we need to own that same process for obesity.

Audience Member 2 (44:50):
We are seeing anti-inflammatory effects and better outcomes for things like Crohn's disease and cardiovascular events. If we believe in prevention, let's prevent type 2 diabetes.

Angela Fitch (46:22):
There was a 94% relative risk reduction for developing diabetes with GLP-1 medication. We could almost get rid of type 2 diabetes. We need a public health emergency approach to this, similar to COVID, so individual companies aren't the only ones pointing fingers at costs.

Audience Member 3 (48:13):
Regarding GLP-1s, many were originally for diabetes. Is there going to be a day where they are looked at for both, rather than insurance companies using "primary purpose" as red tape?

Angela Fitch (48:41):
That day is today. In Europe, Tirzepatide (Mounjaro) is the same name for both indications. In the U.S., the FDA made them launch as separate brands. You have to push back on insurers. Obesity shouldn't be a second-class citizen to diabetes.

Audience Member 3 (52:02):
Is there enough data on side effects?

Angela Fitch (52:13):
The drug class has been around for 20 years. We have five-year trial data for Semaglutide, and more coming for Tirzepatide in 2027. The benefits significantly outweigh the risks. However, these shouldn't be handed out via a simple internet form; they require comprehensive care.

Audience Member 4 (55:38):
Is the expectation to stay on it for life? If they get off, do they gain the weight back?

Angela Fitch (55:52):
Yes, for the most part, the expectation is long-term use. If you stop blood pressure or diabetes medicine, the condition returns. While some people make radical lifestyle changes and can maintain, for the majority, it is a chronic treatment.

Audience Member 4 (56:32):
If it costs $12,000 a year but saves $4,000, the math is still tough for some.

Angela Fitch (56:44):
The $1,000 is list price. The net cost depends on rebates. But if the cash price is $499, push back on your PBM. We are also advocating for the "Treat and Reduce Obesity Act" so Medicare covers it, which usually leads the rest of the market. There are leaks that Medicare (CMMI) will do a project on obesity in 2026. The times are changing.

Alyssa Place (59:09):
I think we're over time, but I really appreciate the great discussion. Let's give one more thank you to Dr. Fitch.