December 09, 2024

Introduction

The health and cost effects of obesity have been a concern for large employers and their health industry partners for nearly two decades, but never more than in recent years. According to the World Health Organization, obesity has more than doubled among adults since 1990, and now, more than one in eight adults are living with obesity around the globe.¹  In the U.S., where 40.3% of adults have obesity, the highest prevalence is concentrated among working-age adults (ages 40-59).² This is cause for alarm among employers because obesity is associated with numerous costly conditions that can reduce quality and length of life. For example, obesity is a risk factor for cancer—the top health care cost driver for employers in 2024—with the American Cancer Society estimating that excess body weight is responsible for about 5% and 11% of cancers in men and women respectively, and about 7% of cancer deaths.³

As obesity increases globally, so are the costs of treating this complex disease. GLP-1 agonists (GLP-1s) are among the top drivers of health care cost increases for most employers according to Business Group on Health’s 2025 Employer Health Care Strategy Survey.⁴ Thus, employers are challenged to provide a comprehensive weight management strategy that addresses employees’ health care needs and increasing cost trend.

To achieve this balancing act, employers must revisit their weight management strategy to ensure that it approaches obesity as a complex, chronic disease, providing evidence-based programs and benefits focused on multiple levels of care and ensuring that these benefits are delivering positive clinical outcomes for the investment.

Weight Management Programs Must be Evidence-based, Comprehensive and Globally Relevant

Existing and emerging research demonstrates that obesity is a disease driven by multiple and often interrelated factors, including biology, environment and behavior. Due to the complexity of obesity, employers need to offer a spectrum of evidence-based treatments, including intensive behavioral interventions, anti-obesity medications and bariatric surgery. Each type of treatment has research showing it can lead to clinically significant weight loss, positive health outcomes and improved quality of life; each also comes with important considerations for employers and their health industry partners.

• Intensive behavioral interventions must focus on whole-person health: Evidence shows that these interventions, which engage patients in behavior change strategies to alter their eating and exercise habits, can lead to clinically significant improvement in weight status (5% weight loss) and reduced incidence of type 2 diabetes in people with obesity.⁵ However, research also indicates that the benefits of these interventions depend on the design of the program, specifically the number of sessions (i.e., intensity), peer support and personalization.⁵ These interventions must also include maintenance and/or relapse prevention strategies to increase the chance of success over the longer term. Beyond these critical components, there may be advantages to incorporating aspects beyond nutrition and exercise into intensive behavioral interventions, such as addressing sleep, stress, mental health conditions and social determinants of health. These topics may require assessment, education and referrals, making it critical for employers to work with their vendor partners to ensure that intensive behavioral interventions are tightly integrated with other benefits and programs.
• Anti-obesity medications should be offered with wraparound support: Although intensive behavioral interventions can be effective, many people with overweight and obesity cannot achieve clinically significant weight loss through these interventions alone. Therefore, for those who qualify, anti-obesity medications can be a useful tool; clinical trials, along with studies of employees in the real world, show that people who take these medications (both GLP-1s and non-GLP-1s) achieve greater weight loss than those who engage solely in behavior change interventions.⁶  To maximize success while patients are on anti-obesity medications, including helping them manage any potential side effects and minimize weight regain if/when they come off these medications (thus, reducing potential waste), anti-obesity medications must be offered alongside multidisciplinary patient support, such as through obesity treatment programs, cardiometabolic programs or within an advanced primary care setting. One way some employers are ensuring that anti-obesity medications and wraparound support are used together is requiring patients to participate in a weight management or a similar program to receive coverage for GLP-1s. Employers must work with their vendors to ensure the adequacy and efficacy of patient support through the reporting of outcomes.
• Bariatric surgery coverage should direct eligible patients to high-quality care: Decades of research show that bariatric surgery leads to sustained weight loss, as well as numerous positive health outcomes (e.g., diabetes control and remission, reduced risk of heart failure, dyslipidemia improvement and hypertension remission, reduced cancer risk), along with lowering mortality risk.⁷ Although recent research indicates a decline in bariatric surgery from 2022 to 2023 in the U.S.— which may be due to the rising popularity of anti-obesity medications—employers should continue to offer coverage for bariatric surgery.⁸ For populations in the U.S., a comparison of bariatric surgery and GLP-1s found that bariatric surgery is more cost-effective than GLP-1s, with study authors indicating that the price of GLP-1s would need to decrease by 75% for these results to change.^9,10 Beyond cost effectiveness, bariatric surgery offers an important treatment option to individuals with obesity who may not respond favorably to intensive behavioral interventions or anti-obesity medications or who may choose a more durable weight loss option. Employers providing coverage for bariatric surgery should require employees and covered dependents to undergo surgery at a Center of Excellence (COE), as research indicates that COEs offer superior outcomes and patient experience. Employers also should work with their partners, including the COE, to determine appropriate presurgery requirements, including the use of anti-obesity medications, as new research indicates that the use of GLP-1s before surgery does not lead to significantly improved outcomes among patients.^9,10

Crucially, the aforementioned benefits must be implemented in the context of a supportive workplace culture that prioritizes nutritious food choices and movement, as these elements underpin the success of any type of obesity treatment. The promotion of physical activity, and nutrition in particular, can increase the likelihood that employees with obesity are successful with behavioral, pharmacological and/or surgical treatments; they also have the potential to play a role in preventing the development or progression of chronic diseases, including obesity, across the entire population. Employers can influence nutrition and physical activity through workplace design, organizational norms related to food and movement and the well-being initiatives offered, including those that seek to address inadequate access to healthy food or physical activity in the community.

Multinational Employer Considerations Related to Providing Comprehensive Care

Each government’s suite of obesity interventions differs, including the types of treatments and quantity available, with coverage sometimes varying by city or province around the world. For employers with operations outside the U.S., it is imperative to adapt the weight management strategy and specific solutions to meet region and country specifics, including cultural trends regarding diet and the availability of programs, medications and other treatment modalities like bariatric surgery. This approach requires assessing what is offered at the government level and identifying the coverage and cost gaps that impact executing the company’s weight management strategy. Employers with a captive in place can use it to address government/public gaps in coverage. In addition, employers will need to stay abreast of the changing landscape, particularly related to availability and cost of pharmaceuticals, as they consider how best to support their employees.

Weight Management Programs Should Deliver Positive Outcomes

As employers grapple with rising health care costs, including those associated with obesity and related conditions, they will need to increasingly focus on the outcomes associated with their weight management strategies. Driving positive outcomes will in part be dependent on designing benefits and programs based on the best available evidence as described above; it will also require employers to hold vendor partners accountable in new ways.

As a first step, employers must set clear expectations with vendors about reporting short- and longer-term outcomes. Outcomes should go beyond participation and even quantifiable weight loss and may include variables like better cardiometabolic health, higher quality of life ratings, reduction of adverse events and improved productivity. The greater the specificity in the outcomes reported, the deeper the understanding about whether the benefits employers are offering are making a meaningful difference in the lives of employees.

Beyond designing evidence-based programs and benefits and setting reporting expectations and requirements, employers should explore options related to outcomes-based payment for weight management-related vendors, especially those offering services outside the core insurance program. Tying payment to health outcomes, including those reported by the patient, will enable employers to hold their partners accountable for treatment effectiveness.

Conclusion

Now more than ever, providing evidence-based treatment for obesity that prioritizes health and well-being outcomes is a priority for employers. Rising health care and pharmaceutical costs have created an imperative for employers to reassess their current weight management strategy, make changes to drive greater impact and hold partners to higher standards – all in pursuit of healthier employees and lower health care costs.

Related Resources

• An Employer's Practical Playbook for Treating Obesity
• Global Guide to Obesity
• Managing GLP-1 Medications and Related Costs
• Food as Medicine: Nutrition Interventions for a Healthier Workforce
• Podcast: Exploring the Landscape of Obesity Treatments
• Podcast: Pediatric Obesity: Expediting Access to a Full Spectrum of Care

More Topics

Resource Health Conditions and Risk Factors Physical Health Culture and Strategy