Where Obesity, Mental Health, and Ozempic Converge
Are the costs worth the benefits?
Approximately one in five Americans are living with obesity, the Centers for Disease Control and Prevention (CDC) estimated in 2022.
The disorder, in which a person’s body mass index (BMI) is 30 or greater, results from abnormal or excessive fat accumulation, potentially causing comorbid medical conditions including Type 2 diabetes, heart disease, and cancer.
People living with obesity have an 18% to 55% higher risk of developing depression, according to studies cited by the National Institutes of Health (NIH), which found a “strong association between obesity and psychological issues.” Conversely, other NIH studies indicate that people with depression are more likely to experience obesity.
In the workplace, employees with obesity are 25% to 68% more likely to be injured at work than normalweight workers, according to another NIH study comparing employee injury statistics to self-reported weight and height. The study concluded that weight reduction policies and management programs targeted toward employees with obesity can prevent or reduce workplace injuries.
“Studies show a correlation between obesity and the frequency and severity of injuries, along with a related impact on disability durations,” says Daniel Rufenacht, vice president of workers compensation claims at QBE North America. “The correlation clearly suggests the ‘common sense’ value of employer-provided weight loss programs.”
Should such policies and programs include prescriptions for glucagon-like peptide-1 (GLP-1) medications like Ozempic or Wegovy? The breakthrough drugs offer the opportunity to reduce an obese person’s BMI, which in turn may decrease the risk of both comorbid mental health conditions and the frequency and severity of physical workplace injuries.
Most corporate health plans now cover GLP-1 medications to treat Type 2 diabetes but not weight loss. The workers compensation system does not cover either weight loss or diabetes as they are not considered work-related illnesses, but certain state programs may cover workplace injuries made worse by the conditions.
A key question all states face is whether a positive impact on workplace injuries and related return to work scenarios is worth the drugs’ high costs. A one-month supply of Ozempic costs roughly $935 in the United States, without insurance. But the drug can be purchased for $155 per month in Canada and $50 per month in Germany.
“Will it be one of our top drugs? It sure could be,” says Tron Emptage, chief clinical officer at health services provider Optum. “The jury is still out.”
High Costs and Uncertain Benefits
Both GLP-1 medications already have taken the market by storm, a recent Accident & Health Market Report by QBE North America suggests. From 2020 to 2022, the study found a 300% spike in Ozempic and Wegovy prescriptions in the United States, with sales hitting $5 billion in the first half of 2023. “The anticipated impact on health plan costs could increase to 55% per member by 2025,” the study projects, since most health plans are just beginning to cover the cost of the prescriptions for diabetes. The CDC in 2021 reported crude estimates of diabetes prevalence in the U.S. population, saying approximately 38.1 million adults 18 years and older in the United States have diabetes (more than 90% with Type 2 diabetes), suggesting a large market for the drugs.
Tara Krauss, head of accident & health at QBE North America, cites both pros and cons for the medications. “If current research into the drugs’ efficacy proves accurate, they appear to offer a myriad of health benefits beyond weight loss, including possible decreases in kidney and cardiovascular disease, arthritis, joint pain, and inflammatory bowel disease,” Krauss says.
The downsides include a range of potential side effects. Dr. Michael Choo, chief medical officer at specialty care management provider Paradigm, points to significant gastrointestinal issues such as pancreatitis and biliary dysfunction. “There is also some concern for the increased potential for thyroid cancer among GLP-1 users. The bottom line is that the long-term health effects are unknown at this point,” he says.
Krauss cites other possible medical issues like muscle loss and apathy. “Research I’ve read on GLP-1 medications indicate reductions in cravings for alcohol, tobacco, and opioids, which is a positive for Ozempic and similar drugs, but that may factor into people feeling apathetic,” she says.
Choo notes also that the level of weight loss produced by using GLP-1 medications plateaus over time and weight gain returns if the individual ceases taking the medication. That could result in long-haul costs for employers that cover the drugs. “These medications are extremely expensive, and there are other methods to increase weight loss
that are available,” he says.
Krauss has a similar perspective. “It has to be a really thoughtful decision. If an employer covers it and then decides a few years down the line to stop covering it, employees will likely not be able to afford the cost of the drug on their own and could have no choice but to discontinue use and likely regain the weight they lost, reversing any benefit gained and causing adverse physical and mental health effects,” she says. “Larger long-term studies are needed to verify both the drugs’ benefits and risks.”
Is Workers Comp a Recourse?
Assuming more data supports the weight loss benefits of taking GLP-1 medications, will state workers compensation programs begin covering the cost? Reuters recently cited “the very real possibility” that “weight loss drugs will be approved treatment in workers compensation claims.” The news service noted that many workers compensation programs regularly denied chiropractic treatment claims for injured workers in the past, but several states like Oklahoma now accept such claims.
“If the drugs are helping the population as a whole reduce obesity, I don’t think it’s too much of a stretch to say we would expect a positive impact on worker safety and better injury outcomes,” says Rufenacht. “As data emerges from more published studies showing the drugs’ impact on workplace injuries, I can definitely see more attention being paid to their potential benefits.”
