Employers that don’t cover obesity drugs should ask themselves why, said Noel McKay, principal consultant at Cowan Insurance Group, during Benefits Canada’s Face to Face Drug Plan Management Forum on Dec. 9, 2020. “Is the risk of driving up benefits costs the reason? If so, I don’t think you have to fear it. Maybe two per cent of employees will ever claim for a medication used in the treatment of obesity. Embrace the value of it, not just the cost.”
In 2017, a study by Obesity Canada reported that 29 per cent of employers thought their wellness programs encouraged workplace health, while only 12 per cent of employees living with obesity thought the same, said McKay. The study by the non-profit association also reported 76 per cent of employers felt their wellness programs contributed to the success of weight-loss attempts, while only 32 per cent of employees with obesity agreed. Further, all but one of the 150 employers surveyed said they had a wellness program, but only 39 per cent of employees with obesity agreed, he added, and only 26 per cent of those people participated in a wellness program.
There’s a trend here, said McKay. Employees living with obesity are seeing a lack of equity and inclusiveness, but employers think otherwise.
Plan sponsors should also take a look at this issue through the lenses of diversity, inclusion and equity, McKay said. Are equity and inclusion considered in your prescription drug coverage? Are medications used to help people with obesity covered in your benefits program? Do your drug formulary and employee benefits program reflect your company as an employer of choice?
He noted plan sponsors should enable access and not build barriers, and they should highlight services included in employee and family assistance programs for those living with obesity. “Don’t keep it a secret — find out what’s there and let your employees and their families know.”
The last Canadian Adult Obesity Clinical Practice Guidelines was published 15 years ago, in 2006. Since then, things have changed, said Dr. Sean Wharton, director of Wharton Medical Clinic, who also spoke during the session. “Our recognition and understanding of obesity as a chronic disease has changed. We no longer think of it as a lifestyle problem.”
The epidemiology of obesity is that it’s a growing problem, said Wharton. In Canada, approximately 26 per cent of the population lives with this condition, he added, and the economic burden that comes along with this is significant. One of the key things that made the 2020 Guidelines different was the direct inclusion of patients’ voices, he said. Patients disclosed they felt clinicians’ biases and opinions surrounding obesity weren’t helpful. “If we can work on a compassionate and empathic, patient-centric focus that helps with the impairment of health, we’re in a much better position.”
Obesity bias can be changed through understanding the biological processes, Wharton noted, as the drive for elevated weight is a brain-related, neurochemical problem. In fact, there are genes that code for specific components that drive obesity, he added, and by understanding this, there’s a chance of decreasing weight.
When it comes to obesity treatment, medical nutrition therapy or dietary interventions don’t need to be calorie-restricted, but focus on healthy eating parameters, said Wharton. The previous guidelines advised patients to reduce energy intake by 500 to 1,000 calories on a daily basis; however, there’s no evidence anyone can do that effectively, he noted. Instead, calorie restriction comes from three pillars: the psychological, the pharmacotherapy and bariatric surgery. “Our foundations will always be good dietary behaviours and physical activity, but those two foundations are only supported by the three mechanisms that allow the calories to go down.”
Individuals living with obesity have a lot of stored energy and need a mechanism for using it, Wharton said. Pharmacotherapy tells the brain to calm down extra eating components and use stored energy, he added, noting there are three options in Canada. First-line treatments; if someone has pre-diabetes, diabetes, high blood pressure, obstructive sleep apnea, polycystic ovarian syndrome, GLP-1 analogues like liraglutide should be included, noted Wharton. Further, if someone has depression, smoking or cravings, then bupropion or naltrexone is recommended, he added.
Read more stories from the 2020 Face to Face Drug Plan Management Forum.