Episode 38 – Obesity and What it Means for Plan Sponsors

Mike Stull (0:08)

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All right, let’s get started today.

Joining us again is George Huntley, CEO of the Diabetes Leadership Council. We’ve had George on a couple times to talk about the patient experience with diabetes and things that employers should be thinking about as they design their benefits for those with that condition. And today we’re taking a little bit of a different but related turn in that we are talking about what’s happening in the very popular topic of obesity. So, I hope you enjoy George and I’s discussion.

Let’s get started. George, welcome back to the podcast to get started. Maybe a quick reintroduction of yourself to our audience.

George Huntley (3:12)

Sure, Mike. Thank you for having me again.

My name is George Huntley. I’m the chief executive officer of the Diabetes Leadership Council. We’re an advocacy organization working on affordability and access to medications for people with diabetes and all the things they need in order to survive and thrive. I’m a patient living with type one diabetes for 40 years.

The other side of my life, I’m also the chief financial officer of a professional services firm based out of Indianapolis, Indiana. And so in that role, I’ve been the plan administrator of a self-insured health plan for over 25 years.

Mike Stull (3:45)

Yeah, we’ve talked about it in the past. It’s a great perspective because it’s multifaceted, right? Patient, advocate, and employer. So appreciate you making time to talk with us today.

Previous podcasts we’ve done have focused primarily on diabetes. I know today we’re going to shift gears a little bit, but not too far off course, because we know that obesity is a problem that continues to grow in the country and continues to be a hot topic and very interrelated to the issue, particularly of type two diabetes. So maybe talk a little bit as we start just around from your perspective, you know, how large of an issue is obesity for employers and what’s really driving this current interest in how to tackle the problem?

George Huntley (4:45)

Yes. You know, obesity is one of the largest drivers of type two diabetes today and puts it squarely in the crosshairs of the Diabetes Leadership Council as something that we need to address. But, you know, nearly half of all working-aged Americans today have obesity. And by 2030, the estimate is, you know, half of all Americans will have obesity. So it’s a big, big number. And one in four have severe obesity, which is class two or three, which means their BMIs are over 35 or 40. You know, we have a lot of plan participants dealing with this disease right now, all of us listening to the podcast.

But the recognition of it as a disease is lagging, which is why we’re out trying to spread the word and talk about this as a disease.

Mike Stull (5:34)

Yeah. So let’s talk about, you know, obesity as a disease.

I know, you know, a lot of people, particularly people who haven’t dealt with obesity or being overweight, you know, believe that it’s really a matter of someone having the right habits, the willpower to eat right and exercise. And certainly that’s part of it, but there’s more to it. And so maybe talk to the audience about, you know, what the science is saying today.

George Huntley (6:09)

Yeah. And you’re exactly right. Diet and exercise is a key piece, but it is far beyond that.

So first and foremost, obesity is now a disease recognized by the American Medical Association, the World Health Organization. Many, if not most of other leading health organizations are recognizing obesity now as a disease and have actually done so for the last decade. But unfortunately, there’s a real stigma around it. And so what you’re seeing is obesity is not being diagnosed. It’s being undertreated. And there’s an unhealthy cycle around that. That’s, you know, we need to all work together to break. It is a metabolic disease that makes it difficult for a person to lose weight. It has genetic components, surely runs in many families, just like diabetes does.

But it also has environmental factors, you know, access to healthy food, exercise options, et cetera. All these things are working together. But first and foremost, we’ve got to stop blaming the patient. You know, we’ve got to stop blaming the patient. It’s not the patient’s fault. And if we could all stop and just say that out loud, I think we will have gone a long way in helping.

We actually need to work on monitoring and managing this as a disease. A patient’s body is fighting to stay at its highest weight level. That’s what the body does. And it’s storing fat, it’s storing energy for a famine, which a few centuries ago was just perfect. But today it’s actually a health problem. So, you know, it’s important to understand the obesity patient’s metabolism will slow down as they diet and exercise. And, you know, you want it to speed up, but in fact, it’s slowing down despite all this exercise. And it’s why a vast majority of these people with exercise and diet wind up regaining their weight even afterwards, because it’s just genetics that’s causing this to keep happening. So we’ve got to move from blame to biology and actually work the problem.

Mike Stull (8:21)

Absolutely. And I like the, you know, you brought up environmental factors and, you know, one of the things that I’ve tried to do for myself is lower the amount of sugar that I take in. And one of my favorite foods is cereal.

And I spent a day just going through all the different “healthy” cereals, and I use healthy in air quotes, you know, looking at their nutritional labels and the amount of included sugar, even on things that you think would be, you know, that are even advertised as healthy cereals is just unbelievable. So, I mean, you really have to make a concerted effort and an informed effort, you know, to change your eating habits pretty drastically, you know, to get away from some of the stuff, the bad stuff that they’ve, you know, just injected into our foods.

George Huntley (9:20)

You’re quite right.

And cereal is one of the most challenging things for a person with diabetes to eat, actually, ironically, because it will spike your blood sugar like nobody’s business. It really is a challenge. I try to avoid it, but I love cereal.

Mike Stull (9:39)

So let’s get back to the question of, you know, why are we talking about this now?

George Huntley (9:41)

Sure. Well, we’re talking about this now because for the first time, actually, there are real treatment options to successfully treat obesity. And there are several more on the way. So we now have tools in the toolbox to address the issue holistically. And, you know, we’re talking about the new GLP-1 drugs that are out there, the Wegovy, the Mounjaros of the world. There will be many more coming because a lot of money is being put into development on this. And a patient on these drugs can lose 15 percent or more of their body weight. And that is, that’s really moving that needle. Whereas before, you’d struggle to find a drug that would, or anything that would help you move, lose more than 5 percent. When you have someone with severe obesity, and that’s really where you’re, where you’re looking at. So the diet and exercise isn’t really working for them.

You can lose 15 percent of your body weight on these, on these medications, and even more when you’re combining it with diet and exercise. It’s a really big deal when prior to this, the only option they had really was, was a fairly invasive bariatric surgery. And so if you think about half the country having, having obesity, we can talk about all of the things that obesity, obesity leads to as we think about, you know, why, you know, why these drugs are so important.

Mike Stull (11:10)

And I know one of the concerns that folks that I’ve spoken with have is, as it relates to these drugs, you know, do people have to take them for the rest of their lives? Or once they lose weight, can they stop?

George Huntley (11:23)

Yeah, unfortunately, what we’re seeing is it’s, it’s, you got to stay on this therapy for life. And, and what people need to understand is these GLP-1s are essentially a hormone replacement. It’s a, it’s a, they’re mimicking the gut hormones that are telling your brain that you’re full, and it’s impacting the speed with which your stomach digests and empties. So you’re full longer, and it really turns into a successful weight loss in the process. But as with anything, if you stop taking the drug, you stop taking that hormone replacement, you go back to the, the state that you were in before. Just like with blood pressure, cholesterol medications, if you stop taking those drugs, the problem returns. The same, unfortunately, is the, is the case with, with these obesity medications.

Mike Stull (12:17)

And that’s an interesting point. And a little, you know, a little off from our, our prepared questions, but I mean, as it relates to, to hormones, and, and you talked about, you know, this being a hormonal issue earlier, and in some cases, I mean, I even think of it in, in regards to almost like addiction.

And so, some of the same types of issues where, you know, people, you know, end up eating either more food than they, they should, or foods that they shouldn’t eat because they’re not healthy, a lot of times, you know, to fulfill some type of craving. And, and I know, you know, for me in particular, someone who battles weight, you know, sometimes those cravings are just, they’re really tough to battle. And so it’s, it’s interesting that we’re, we’re starting to tackle the, you know, as you said, the hormonal piece, the brain chemistry piece. That’s, to me, is some of the most interesting parts of these, these new drugs, maybe some of the scary long-term parts of them, but also some of the most interesting short-term.

George Huntley (13:33)

Yeah, I think, well, I think it takes you into a place where we also, you know, we needed to get to, which is a good segue to it, is, is the, the behavioral therapies that need to also be included in this. So, you know, if we think about how you treat obesity, you’ve got diet and exercise, but the patient needs help.

So you think about nutrition therapy, you think about intensive behavioral therapy, the diet and exercise, this is, you think about diet as, oh, I’m going to go on a diet, which means I’m going to go off of that diet. No, this is a lifestyle. This is forever.

And so the, the individual, your employee, these plant, we need, we need help in making that change and making that pivot forever. And it’s really important that as, you know, you think about of all the things on our healthcare plan, that’s really inexpensive stuff to nutritional therapy is cheap compared to all of the other things that you could be doing. We’ll give away, you know, as many smoking cessation plans as, as, you know, in our wellness programs, as, as the person wants to go through, because we really want them to succeed in quitting smoking, but will not cover nutritional therapy, will not cover behavioral therapy.

And in some cases, in some of these areas, they’ll follow the Medicare guides and the Medicare guides on some of this is, is written where nutritional therapy and behavioral therapy has to be done in a primary care physician office. Well, one, you can’t get to a primary care physician and two, those offices don’t have a nutritional counselor there. It’s, I mean, the barrier to access is, is quite high. And again, these employer needs to dive into their plan design and actually think about these things, because again, that’s really cheap compared to all of the other therapies that we’re talking about. That stuff’s really inexpensive.

Mike Stull (15:29)

Yeah. I remember when we used to do local meetings with, with diabetes patients here in the Akron-Canton area, and we would do these Saturday workshops with patients and some local certified diabetes educators from local hospitals. And we would have the nutritionists from one of the local hospitals come in and speak. And regardless of who else we had speak, the nutritionist was always the most popular because people have so many questions, right? Because there’s so much information out there, like you said, about, you know, diets and fads and, oh, this is good for you. And then it seems like the next year, oh, that food isn’t good for you. So, you know, just helping people understand, you know, at a basic level, what’s, what’s good for you and what’s not, I think, can help a lot of people.

Well, we know that, you know, these, these drugs back to the, the medications themselves, we, we know if, if they were not so expensive, I think every employer would line right up and, and cover them and, and everyone would, would have access. But unfortunately, as we’ve talked about in previous podcasts, patients end up getting stuck in the middle. And so curious your thoughts in terms of the price of the drugs and, and how employers should approach this from an ROI perspective.

George Huntley (16:53)

Yeah. And yeah, it is a concern. It’s, it’s obvious, it’s the elephant in the room and the employers need to work with their PBMs and their TPAs, third-party administrators, in, in getting access to these and negotiating for access to these treatments. Many, and many of them are starting to cover them. It’s actually surprising how many are actually beginning to, to start covering these. And I think you’re going to see it more than, more and more. I would say the employer also needs to bear in mind the full direct and indirect costs of obesity.

You know, a person with obesity on average is, costs 50% higher in annual medical claims than a person, a normal weight person, if you will. And that issue is already driving their healthcare costs, but they don’t even know it because very few are actually tracking the rate of obesity. If you think about a health plan and you’re trying, I know exactly how many people have diabetes in my health plan, but I actually don’t know how many people have an obesity in my health plan because it’s not diagnosed. It’s not put on the patient’s chart. So, you know, start, what gets measured gets managed. That’s business 101 and we’re not measuring obesity. And we clearly need to be. You know, it also leads to several very expensive comorbidities as does diabetes, but type two diabetes being, you know, a very obvious comorbidity of obesity. It also leads to several cancers, heart disease, hypertension, stroke, and many, many other areas.

That list is actually longer than what the diabetes comorbidity list is that drives up the overall cost. And that linkage is not being made very well yet from an ROI perspective. And I think you’re going to see more and more studies show, you know, the drop off in some of those other costs as time goes on.

You know, a patient with obesity is also typically given a higher dose of whatever medication they’re in very often. And if that medication is, you know, a thousands of dollars specialty drugs that can add up pretty quickly too. So there’s a lot of different areas where you, your employer should be looking to get that true ROI. And I think as time goes on, we’re going to see more and more information for them to grab hold of in this. It also drives a higher absentee rate. So productivity is down. I think the latest stat I saw was, you know, an average three work days a year in absenteeism. You know, so many things they need to look at. And then finally on this, as we think about employee retention, you know, it’s amazing, you know, how tight the labor market stayed despite the, all the economy and the inflation and the unemployment rates stayed low through all of this.

Covering these anti-obesity medications will become an employee retention tool. And, you know, we said there’s a recent survey that showed 44% of people with obesity would actually change jobs to gain access to medications. And more than half of them would stay at a job they don’t like to retain coverage of these treatments. So the employees are going to start demanding this and speaking to it. And I think that’s, you know, it’s something that the employer’s not going to be able to, you know, to avoid.

Mike Stull (20:23)

Yeah, all good points.

And I think it’s, again, just from the employer perspective, certainly, you know, thinking about the direct costs, the indirect costs. And I think the other interesting thing about these medications is it’s not, you know, if it works like it’s supposed to, it’s not a 5% reduction. It’s, you know, upwards of a 15% reduction in body weight and what a difference that can make for an individual. Like you said, both from comorbidities, but also just energy levels and present, you know, reducing presenteeism. And you mentioned absenteeism. So yeah, a lot of indirect benefits there as well.

George Huntley (21:09)

If I can interject very quickly on that point, that 10 to 15%, that 10% rate is that sweet spot where you really start getting health benefits from it. You get some at 5%, but when you get to 10% of body weight reduction, you really start getting into health benefits that are tangible. So somebody who’s 300 pounds need only lose 30 before they want, they don’t need to get back to your high school weight. So that’s also important for everybody to understand. You don’t have to be your high school weight. I don’t fit in those clothes either.

But you lose 30 pounds, if you’re 300 pounds, you’ve made immense progress in improving your health and, you know, do that math for anybody. 10% is pretty easy, but it’s hard to achieve, but the math is easy.

Mike Stull (21:58)

So we talked about the behavioral piece of this.

We talked about the medication piece. What else should an employer consider as they’re thinking about how do you take the fight to obesity?

George Huntley (22:10)

Well, first they need to recognize that they have a role. You know, first and foremost, employers, as we know, cover half the country. Half of the workforce, work age American, working age Americans have obesity. So the employer cannot avoid this, their role in this fight. They have to get involved.

You know, beyond healthcare, the number one thing that employers should do is look at their own internal biases and stigmas in their communications. Weight bias is very real. And in stopping, it’s going to take all of us recognizing it, that it actually exists.

And, you know, these employees, employees with obesity are not lazy inherently, but people think about that overweight person as lazy, slow, et cetera, less intelligent. These are, these are biases and stigmas that need to be removed from our, from our thought process and from our workforce and our workplace. And so they’re also, they also tend to not earn as much. So when reviews come, are they looking at their, their employee base on a blinded level, or are they, and when you’re hiring, are you hiring on a blinded level, but from an obesity perspective, what is your internal communications with regard to it? A lot of wellness programs, if you do a wellness program, the goal can’t be a certain amount of weight loss. It’s very easy for, oh, we’re going to have a, we’re going to have a wellness program. And the person who loses the most weight is going to win the cake, pun intended. That’s a terrible, terrible analogy, but you know, that’s really not the way you should do this because it’s very hard. You know, we should be, you know, encouraging the right overall wellness behaviors and, and, you know, well-intended moves can actually backfire.

So, look at your own internal biases and start within the HR department, but also talk about how you’re, how you’re communicating with your managers and others to make sure weight bias is not propagated and promoted throughout the organization, even unconsciously.

Mike Stull (24:30)

Well, very good. I appreciate George, you providing your, your perspective on this. It’s certainly something that as we go out and meet with our employers and our clients, we’re talking about with nearly every one of them. And so I appreciate you giving us the perspective from the patient’s point of view. And I always like to give you an opportunity at the end to plug the organization.

So, if people want to learn more about the Diabetes Leadership Council, where do they find you?

George Huntley (25:03)

Oh, super. Thank you. www.diabetesleadership.org. We’ve got an employer solutions area where we talk about plan design on chronic disease, obesity management.

We’ve got several webinars that we’ve done and a lot of materials you can download and take a look at, but appreciate the opportunity to be on. It’s a pleasure being with you, Mike, as always. And your audience, thank you for listening and eat right, be healthy and take care of your people.

Mike Stull (25:34)

Excellent. Thanks again for being with us. Thank you again to George.

It’s great to hear the role obesity plays in a person’s health from the perspective of someone living with diabetes. We appreciate you and your team and the work you all do for those affected by diabetes.

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