Op-Ed: Employers Are Letting Their Employees Down and Hurting the Health System When They Don’t Support Weight Loss
By Kirsten Axelsen
Helping to change to trajectory of obesity and chronic disease is good for employers’ and for employees’ health and saves the health system money. Moreover, people with obesity are more likely to experience other health conditions, like depression, cancer and heart disease, that cause people to miss work. For all these reasons, many employers, including the federal government, have decided to cover obesity treatments, including counseling and medications, in their insurance plans. However, some employers faced with the initial high costs of treatment have made a rash decision to cut off their employees’ access to that care. The decision to stop is bad for their employees’ health and is fiscally shortsighted.
For people with obesity, getting the help needed and losing weight is hard. Most people who try to lose weight aren’t successful and often gain weight back, so they may seek clinical help. Some encourage those struggling with weight loss to have greater “willpower” and while doing so they ignore the well-established genetic predisposition to weight gain and the links to complicating psychological or social factors. Even with diet and exercise many are unable to lose weight and sustain a lower weight. Once the body has established a higher weight it has a strong momentum. So while helpful, simply suggesting healthy food or encouraging activity is not enough. Moreover, people with employer coverage who were engaged in weight loss counseling with medication support lost more weight than those who had diet and exercise counseling alone.
Obesity affects more than 40% of all people in the U.S. An analysis of employer claims data showed that among working age people with obesity who had insurance in 2018, 88% had at least one visit to a doctor for a complication related to obesity but only 12% received obesity counseling and 2% used an anti-obesity medication. Obesity is growing in prevalence and in severity, with sedentary work contributing to weight gain. Being a person with obesity is stigmatized and is often associated with poor mental health, but mental health may improve with weight loss. Helping people lose weight is not about appearance it is about health.
For all the reasons why coverage for obesity makes good sense, the federal government has required comprehensive coverage for obesity treatments for their employees in insurance plans for a decade, specifically directing plans that they cannot exclude obesity medicine coverage by considering it a “lifestyle” treatment. The rationale cited for this coverage requirement is both the physical and psychological impact of obesity on both adults and increasingly children, as well as the disproportionate incidence of obesity in Blacks and Hispanics.
The presence of new anti-obesity medicines is not the first time there has been a challenge for employers to manage new treatments. Demand for Hepatitis C treatment drove a healthcare cost spike, and as competition and negotiation by insurers drove prices down, cost effectiveness grew more over time. There are many new approvals expected for weight loss medicines expected and competition will continue to bolster cost effectiveness. Stopping short on coverage for comprehensive obesity care sets a dangerous precedent for prevention. Treating a condition is always more expensive than letting it go in the short term.
Employee health insurers have tools to control costs of medicines including the use of a formulary and they are also now seeing strong competition and rebates. One might ask if these decisions to drop coverage are a negotiation tactic driven by the PBM’s for more drug discounts. Such tactics come at the expense of employee health. This would be a shame because the short-term decision to discontinue coverage for medicines that can help employees lose weight is short sighted and robs them of the health benefits from weight loss and improving their health.
Kirsten Axelsen is a consultant to biopharmaceutical companies, a Policy Advisor to DLA Piper, she and a Visiting Scholar with the American Enterprise Institute.
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