As mentioned in earlier blogs within this series, the cost of obesity among employees is immense, and employers need to understand that workplace and employment conditions can actually contribute to employee health. Efforts by employers to encourage physical activity and healthy eating among all employees should be implemented to slow this growing non-COVID epidemic.
Comprehensive Obesity Treatment
Comprehensive obesity treatment coverage offered by employers serves as a complement to the promotion of physical activity and healthy eating. This treatment will typically include three types of coverage benefits: 1) Behavioral/Nutritional Counseling, 2) Weight-Loss Surgery, and 3) Pharmacological Treatment. It is critical, therefore, that employer’s partner with their health plans (insurance companies) and other vendor partners to promote seamless coverage to ensure sustainable success.
- Behavioral/Nutritional Counseling
Improving access to healthy foods and physical activity is a key component to success. But this is just the beginning. Offering evidence-based health promotion programs with proven success may help nudge behaviors in new, healthy directions. One example of this is the National Diabetes Prevention Program (National DPP), which is part of the Centers for Disease Control and Prevention (CDC).
National DPP offers a lifestyle-change program designed to prevent Type 2 Diabetes. This initiative is a year-long intervention that is delivered in person, online, through distance learning, or through other approaches in group settings. This 16-segment curriculum is spread over 12 months and is designed to meet stringent CDC requirements. Research demonstrates that this program is highly successful. People with prediabetes who have taken part in this program, and have lost 5-7 percent of their body weight, can reduce their risk of developing type 2 diabetes by 58 percent. Results a decade after initiation of the program are impressive: “Program participants were one-third less likely to develop type 2 diabetes than individuals who did not join a program.”
- Weight-loss Surgery
Weight loss surgery is also known as bariatric and metabolic surgery. According to the American Society for Metabolic and Bariatric Surgery, there are five different weight loss surgeries, each having advantages and drawbacks depending on the medical history of the patient and unique medical circumstances based on risks. The goal of these surgeries is to modify the size of the stomach and intestines to treat obesity and other related diseases. By making the stomach smaller and bypassing a portion of the intestine, less food will be consumed and changes will occur in how the body absorbs food for energy. This results in decreased hunger and increased fullness. The surgery improves the body’s ability to achieve a healthy weight.
Weight loss surgery also requires an overall treatment plan that includes lifestyle modifications, such as nutrition guidelines, exercise and behavioral counseling. To qualify for one of these surgeries, general medical guidelines use body mass index (BMI). An adult with a BMI of 40 or higher may qualify. But surgery may also be an option for an adult who meets other conditions if they have a BMI of 35 or higher – such as having at least one obesity-related medical condition and at least six months of supervised weight-loss attempts. Mayo Clinic provides these guidelines here.
Because safety of any procedure is paramount, using an Accredited Center for obesity surgery is usually stipulated by insurance companies. Based on a 2019 Bariatric Surgery Source article, most insurance companies cover weight-loss surgery. In Iowa, Wellmark, the state’s largest health insurance company, covers weight-loss surgery, subject to the provisions of the various policies they offer.
- Pharmacological Treatment
According to a 2016 study, only one percent of individuals with obesity who are eligible for medication treatment actually receive the medication. One explanation is that there is a tremendous variability in provider prescribing rates and restricted coverage by health plans. Medications used to treat overweight and obesity work in different ways. Some medications, for example, help the patient feel less hungry or full sooner. Other medications make it harder for the body to absorb fat from the foods being consumed.
Similar to weight-loss surgery, qualification for medications to treat obesity typically begin with the individual’s BMI number. If an adult has a BMI of 30 or greater, a physician may prescribe medication for treatment. If the adult has a BMI of 27 or greater, but has a weight-related health problem, such as high blood pressure or type 2 diabetes, medication may be prescribed. Such medications are not a replacement for physical activity or healthy eating habits – all three work together to provide optimum weight loss. The National Institute of Diabetes and Digestive and Kidney Diseases provides an overview on medications to lose weight.
A New Game Changer in Obesity Medication?
In June 2021, the Food and Drug Administration (FDA) granted the approval to Novo Nordisk for semaglutide 2.4 mg (Wegovy™) for chronic weight management in adults with overweight or obesity.
The safety and efficacy of semaglutide 2.4 (Wegovy) were studied in four, 68-week randomized controlled trials. More than 2,600 patients received semaglutide 2.4 for up to 68 weeks and more than 1,500 patients received placebos. From this, individuals who received Wegovy lost an average of 12.4 percent of their initial body weight compared to individuals who received placebo. The most common side effects of semaglutide 2.4 included nausea, vomiting, and diarrhea that were most common during the first several weeks of treatment. These symptoms reportedly abated thereafter. Of course, with about any new medication that reaches the market after FDA approval, little is known about the long-term safety of the drug for those who require ongoing use.
From a local physician perspective, Dr. Kara Thompson, who specializes in weight loss/bariatric surgery and nutrition at MercyOne Des Moines Bariatric Surgery in West Des Moines, confirmed, “The medications for weight loss are safe and effective if given to the correct patient and in conjunction with lifestyle changes. Studies have shown the most effective medications for weight loss is the GLP-1 class that includes Saxenda and Wegovy – but they are extremely expensive.
I inquired with Wellmark about whether this new medication was approved as a ‘covered’ benefit under my health plan. A Wellmark customer service representative responded “this drug is excluded from your pharmacy benefit…prescription drugs for weight reduction are excluded.” Representatives from Novo Nordisk indicated that Wegovy is priced “around $1,340” monthly. For health plans that do cover this medicine, this price may be ‘negotiated’ downward by insurance companies and their selected pharmacy benefit managers.
Prior to Wegovy’s approval, many insurance companies have not covered weight-loss medications. It is unknown how many insurance companies will approve coverage for Wegovy. Novo Nordisk does offer a Wegovy Savings Card that can provide some financial relief, but cost will generally determine just how accessible semaglutide will be for patients. Large, self-insured employers can decide whether or not to include this medication as a ‘covered’ benefit under their health plan, but it will vary by employer. Dr. Thompson states that employers requiring their insurance companies to cover weight loss medications under their health plans would be very helpful in the treatment of persons living with obesity.
This five-part series on obesity touches on the basics of why employers may desire to implement workplace health programs for employees. There are plenty of financial and health reasons for employers to help mitigate obesity in the workplace. Although the body mass index (BMI) is considered to be a fundamental tool in these programs, there are important limitations that must be recognized. Obesity is now widely considered to be a disease, rather than a ‘lifestyle choice,’ and wellness programs that merely address nutrition and physical activity may miss other important approaches that can guide successful opportunities for each individual. Counseling and nutrition programs that address the needs and desires of each individual is a good first step.
Finally, surgery and medication are only meant to serve as a complement to diet, exercise and behavioral mindfulness. Learning as much as possible about the efficacy and safety of these treatments will be key for employers when considering the best ways to support and encourage the health of their employee population. Requesting coverage of weight related treatments, such as doctor visits, nutrition and behavioral counseling as well as weight loss medications and bariatric surgery by health insurance providers is a good first step. If insurance companies have enough fully-insured employers requesting this coverage, perhaps they will provide it as an option. Of course, self-insured employers can elect to include this coverage under their own health plan. No doubt, there are no ‘silver bullets’. However, the core of any program needs to ensure that stigma, prejudice and discrimination are removed from the workplace.
This post is the fifth in a five-part series. Click here to read “Obesity Requires Employer Attention and Focus – (Part 1),” “Is the Body Mass Index (BMI) Useful? (Part 2),” “Obesity – a Disease or a Choice? (Part 3),” and “Employers: Establishing A Culture of Healthfulness – Part 4.”
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