GLP-1s and workforce health: Obesity, Ozempic, and overwhelming unknowns

Despite the overwhelming demand for new GLP-1 prescriptions for weight loss, more than 2 in 3 people stop taking them within the first year.⁹

• More than 82% experience mild to moderate gastrointestinal side effects.¹⁰
• Users have 4 times greater risk for stomach paralysis and bowel obstructions and 9 times greater risk for pancreatitis.¹¹
• Up to 40% of the weight people lose on GLP-1s is actually lean muscle mass, not fat.¹²
• Researchers are looking into the possibility that GLP-1s could increase depression and risk for suicide in some patients.¹³

“We have a pretty good understanding of the short-term consequences of GLP-1s for weight loss. But long term, we really don’t know. And that’s where my concern lies,” says Sean Hashmi MD, MS, FASN — regional physician director of lifestyle and obesity medicine at Kaiser Permanente. “For example, in patients who rely on food for comfort, taking a GLP-1 blocks those reward pathways in the brain, and they could become depressed.”

While we know that GLP-1 therapy is cost-effective for treating type 2 diabetes, it’s still unclear if using it to treat obesity makes good business sense.¹⁶ Considering how costly GLP-1s are, employers are right to be concerned about the potential financial impact of covering them for weight loss — especially since people who stop taking them regain 2/3 of the weight they lost within a year.¹⁷ “These are not drugs employees should take for a few months to lose a few pounds,” explains Dr. Hashmi. “When people stop taking them, their appetite comes back with a vengeance — along with excess weight.”

Questions about supply, demand, ethics, and equity

Ongoing shortages have raised questions about who should have access to GLP-1s — and ensuring availability for people who truly need them. But many virtual, direct-to-consumer companies are aggressively marketing GLP-1s for weight loss and selling prescriptions with little, if any, medical oversight. In fact, only 53% of new GLP-1 prescriptions in the U.S. are associated with a doctor visit.²²

Experts also worry that the media frenzy surrounding these drugs could be harmful to people with eating disorders by reinforcing cultural ideals around thinness. And finally, most employees can’t afford to pay for these expensive drugs out of pocket, which could eventually widen the health equity gaps we already see around obesity.

Obesity is a complex, chronic disease. There’s no one cause, and no single solution.

Understanding your health plan’s GLP-1 cost-containment strategy is the first step — but employers also need to proactively balance emerging science with evidence-based interventions and smart business decisions. Here are some ideas to help you do that.

Before considering GLP-1 medications, physicians should carefully review each employee’s medical history to understand how weight has impacted their health — and what solutions have been explored before. Then, they should work together to create a holistic and sustainable treatment plan that addresses behavior changes, psychosocial support, and socioeconomic stressors — and may or may not include medication.

Ask your health plan how their physicians approach GLP-1s. Make sure these drugs are being prescribed to employees with type-2 diabetes and comorbidities, not just those with obesity. And — although this should go without saying — confirm that covered providers only prescribe GLP-1s for weight loss when clinically appropriate.

If your GLP-1 program doesn’t integrate with your overall weight management program, it’s likely not worth the additional cost. Employees need to be educated before they start taking GLP-1s. And they should be carefully monitored by clinicians who are invested in and informed about their patients’ total health. Obesity treatment works best when it can be modified in real time — including discontinuing GLP-1s in favor of more effective medications.

These drugs have sparked what’s been called a “weight loss revolution.” And we may be entering a new era — not just in how obesity is treated, but how it’s understood.

And as we continue learning, it’s essential for clinicians who prescribe these drugs for weight loss to be deeply invested in their patients’ total health. A collaborative, evidence-based, multi-modal approach is essential for both safety and success. Employers invested in long-term workforce wellness will simultaneously explore the emerging possibilities of GLP-1s while offering holistic, time-tested, and evidence-based weight loss support that goes beyond a prescription.