Do No Harm

The ideal anti-obesity medication produces sustained weight loss with minimal side effects. Today’s AOMs are safe and different from the drugs that were available in previous decades and even recent years. Currently, the FDA has approved six anti-obesity drugs for long-term use. These medications, coupled with a stepped approach should be part of the arsenal needed to support both employers and members.

2. Pharmacotherapy (Medications) + Lifestyle Modification: For those who have not succeeded with lifestyle modification programs or could benefit from additional assistance, adding anti-obesity medications (AOMs) can address some of the challenges that drive weight gain, help decrease appetite and increase adherence to lifestyle modifications.

• • Weight loss of 5% - 10% can be achieved and is most successful when bundled with chronic condition and behavioral health programs. Recently approved therapies are showing weight loss of as much as 16%.

3. Surgical Intervention (Bariatric Procedures): Gastric band, gastric sleeve or gastric bypass involves making surgical changes to the digestive system to help individuals lose weight and is indicated for those who have multiple comorbidities and/or a BMI greater than 35. While these interventions have benefits, they are major surgical procedures that are associated with potentially serious risks and side effects. Long-term success requires permanent changes to diet and exercise.

• • Weight loss of 25% - 30% can be achieved over 1 – 3 years.

MBGH asked a group of employers what actions they are taking for those who are identified as overweight or have obesity. Responses included:

• Offering coaching programs (mentioned most frequently) – including lifestyle modification programs from different point solution vendors or from those that provide chronic condition management programs.
• Tying premium credits or other incentives to engage members in programs.
• Tying incentives to results versus engagement.
• Identifying ways to help members who are located across the U.S. (and in different socioeconomic status regions) to address access and affordability.

The workplace can contribute to the obesity problem, but it can also be part of the solution. There is a need for a paradigm shift away from common weight management programs which focus on self-directed weight loss attempts. Members can struggle and get frustrated with repeated cycles of diet and exercise resulting in a yo-yo effect of weight loss and regain. The stigma associated with obesity that is inherent in weight management programs must also be considered. For members who need the most support, stigma can be a primary reason for the lack of engagement.

Begin by looking at an employee with obesity as a whole person and provide an integrated and personalized strategy which can have greater success at attracting employee interest, as well as sustained engagement. Employees need both the knowledge to make healthy choices and the resources to act on that knowledge. This can be achieved through means as simple as workplace programs on nutrition, physical activity and weight management or an environment that supports activity such as onsite fitness centers and safe walking routes.

Employer Case Study #1

A world leader in manufacturing addressed obesity in their population by defining and instituting a comprehensive well-being program to improve the lives of their employees. Their focus was to create global, people-centric strategies that allowed site-specific adaptations within a supportive environment.

They launched an on-site health coaching program in partnership with local hospitals and point solution partners, provided virtual solutions to meet the needs of their diverse workforce, integrated nutritional counseling with registered dietitians and modified their health plan to include coverage for bariatric surgery and anti-obesity medications. Mental health support was woven into all aspects of their weight management program.

• A personalized approach is imperative to success; one size does not fit all
• Point solution partners must work together to provide a seamless, integrated solution to members
• Communication is key – keep it simple
• Integration of mental health support with weight management programming yields bigger results (in their case weight loss doubled)

Employer Case Study #2

A privately held, diverse supermarket chain implemented an outcomes-based wellness program that included incentives to those who met specific clinical outcomes or showed documented improvement of 3%. Both employees and their covered spouses were eligible to earn the incentive.

To help members succeed, their medical plan covers three consultations with a registered dietitian (annually), “game based” digital health education and health coaching is provided, and primary care medical home clinics are utilized to give participants additional support. The organization employs their own pharmacy team to oversee the prior authorization (PA) process for anti-obesity medications (AOMs). The pharmacy plan design supports the use of generics and as a result, 83% of all AOMs filled are lower cost generics.

Since implementing this program, participants achieved an average weight loss of 8.8 pounds and 33% of the screened population met all their improvement goals. The number of members with multiple risk factors has decreased for the first time since 2014. The company is considering adding coverage for bariatric surgery and is focused on enhancing communications around nutrition services, AOM’s and their condition management programs.

Employer Case Study #3

One of America’s great food companies and leading foodservice distributors started focusing on obesity as a disease nearly a decade ago. However, their geographical dispersity and wide range job roles within the organization (line workers, multiple shifts, white collar, etc.) made it challenging to engage employees in traditional “wellness activities”. In addition, the company was ill-equipped to track the success of their program.

To meet the needs to their diverse workforce, they partnered with a point solution provider to offer a digital behavioral change program that addresses both the mental and physical aspects of weight loss and delivers a science-based, personalized program experience. The program is integrated into their medical plan design with services billed as a preventive medical exam. The clinically proven results include an average of 4% weight loss in the first 10 weeks and 54% engagement in the first eight weeks.

In addition, participants report:

• 89% feel they are more in control of their weight
• 73% have increased physical activity
• 71% report higher self-confidence
• 69% have increased energy levels

Individuals who are overweight or have obesity may benefit from employer assistance to ensure their working environment can accommodate them. Some individuals may also qualify for protections under the Americans with Disabilities Act (ADA) if their weight and associated symptoms (e.g., joint pain, mobility difficulties, shortness of breath, diabetes, etc.) “substantially limit a major life activity.” These underlying conditions may be a disability in its own right, regardless of the person’s weight. The ADA covers individuals who are “regarded as” disabled even if other criteria are not met. This article provides guidance, along with examples of accommodations and ways that employers can help.

Many employers today are focused on providing broad-based lifestyle management programs that address the health and wellbeing of the whole person to support their population with obesity, rather than specific obesity management initiatives. Others provide disease/care management programs that address comorbidities associated with obesity, yet often do not address obesity as part of the solution. When these offerings are made available through health plans or other vendors, they can have an unintended effect of decreasing focus on weight management as an organizational priority.

Alternatively, vendor offerings that target weight management can be made available to members who are overweight or have obesity – this approach can provide a more focused and impactful solution.

Regardless of what direction is taken, it is important to offer a coordinated approach to all vendor solutions to maximize effectiveness and success and to ensure vendors are accountable for outcomes. This is where performance- and outcomes-based contract clauses (see Section 3) can be essential to support long-term health improvement and potential reductions in future health care costs.

When planning an obesity program, it is important to think through how the program will be evaluated and what relevant data will be available for analysis. The measures provided above represent a typical approach to program evaluation; however other measures or data points may also have importance depending on the program setting. For example, some employers may be interested in health equity and want to gain a better understanding of the race/ethnicity and income profile (or job category) of participants to ensure the program is of interest, accessible, and being appropriately used by all eligible individuals.

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