By 2018, over 42% of US adults were obese (BMI 30+) with little variation by age and sex, and almost 10% were morbidly obese (BMI 40+). These numbers continue to increase and until now, no treatment short of bariatric surgery has been effective. Diets result in short-term loss at best, and though the combination of permanent dietary change and exercise often suggested by health care providers (including me) is effective, it has proven exceedingly difficult to implement.
Obesity is far more than a self-image issue as it drives the type 2 diabetes epidemic and contributes in other ways to cardiovascular and cancer risks, musculoskeletal issues, and disabilities. Clearly, more effective long-term control strategies analogous to control of hypertension are needed.
We all know about diet pills, but prescription-strength options have had limited success with side effects ranging from life-threatening to simply intolerable. Over-the-counter options are considered generally ineffective. But, we are now seeing a number of medical articles in major journals reporting on large groups of obese individuals treated for 6–12 months with subcutaneous weekly injections of semaglutide or liraglutide alone, or combined with a long-acting amylin analogue. The first two drugs are GLP-1 receptor agonists, which reduce appetite and are currently used in the treatment of type 2 diabetes mellitus.
Continuing gradual weight loss may reach 20% over many months but requires continued drug use (potentially decades) to avoid a patient’s return to the pretreatment build. Side effects (mainly GI and rarely severe) may be acceptable given the health benefit of such weight loss, but prescription costs are very high. Expect similar drugs or combinations to soon be actively marketed and in wider use.
What this Means for Insurers
New injections options and improved obesity outcomes are potentially good news for life insurers, but not for those paying for the Rx. An underwriting issue will be discerning the reason for use, whether just obesity or for elevated HbA1c values.
About the Author
Michael Fulks, MD, Consulting Medical Director, is board-certified in internal and insurance medicine. After leaving practice, he served as a medical director, creating or editing several underwriting manuals and preferred programs. For the past 8 years, Dr. Fulks has consulted for CRL, participating in its mortality research on individual tests and all laboratory test results, BP and build in combination. He is also involved in the development and implementation of automated screening tools for non-laboratory data.