As effective weight management drugs come to market, it’s time to move beyond outdated approaches to obesity care and towards holistic treatment strategies, said Marie-Hélène Dugal, national pharmacy strategy lead for Medavie Blue Cross, during Benefits Canada’s 2025 Toronto Benefits Summit.
Obesity is a progressive, relapsing and complex chronic disease characterized by abnormal and excessive adipose or static tissue that negatively impacts someone’s health, she said, noting it’s the result of a complex interaction of genetic, environmental, biological, behavioural and social factors. Obesity is identified as a significant risk factor for more than 200 chronic illnesses, including cardiovascular disease, type two diabetes and several cancers.
To date, diagnosis has relied heavily on a body mass index score above 30, which doesn’t tell the full story of someone’s health or weight, said Dugal, and treatment for obesity within a benefits plan has been limited to coverage for weight loss drugs, which were typically classified as lifestyle and either excluded or covered with an annual maximum.
Read: My Take: Obesity should be treated like other chronic conditions under benefits plans
Effective treatment for obesity falls into three “streams,” she said. The first is psychological and behavioural interventions such as coaching and training, which can help people manage their stress, optimize their sleep and regulate their appetite, therefore improving the success of other therapeutic approaches. But they may not lead to weight loss on their own, she said, noting the second treatment approach is pharmacological therapies such as semaglutide and the third is bariatric surgery.
Semaglutide has proven to be a game-changer, said Dugal, but adherence is key to ensuring long-term health outcomes. She suggested better education and management around side-effects so people don’t discontinue the drug.
Medavie sees the typical approach to weight management drugs as outdated. In its prior authorization criteria, the insurer considers more factors than BMI, including waist circumference and whether the plan member has made dietary, physical activity and behavioural changes. It also looks at whether they have any obesity-related complications, such as pre-diabetes.
Read: Claims for obesity, diabetes medications up in 2023: report
“It challenges our perception of ‘What is obesity?’ If you take someone who has a higher weight and think, ‘This person is obese, surely there’s something wrong with their health.’ Well, you didn’t look at their blood pressure, you didn’t look at their blood work. That’s what we’re looking to see.”
That change is making these drugs more affordable for plans and both claims and growth are stabilizing, said Dugal.
The insurer is also moving away from maximums for these drugs to prevent plan members from discontinuing treatment once they hit an annual or lifetime cap, she said, noting that weight cycling has been demonstrated to lead to poorer health outcomes. “The medication is meant to be used long term and so any type of limit . . . is really going against what we understand these drugs are supposed to do and could actually reverse some of the positive outcomes.”
Read more coverage of the 2025 Toronto Benefits Summit.