Prevalence, Management, and Comorbid Condition Trends for Obesity Within US Self-Insured Employers

OBJECTIVES: The US approval of glucagon-like peptide-1(GLP1) agonists for obesity-management has driven patients to seek a diagnosis (Dx) to access these medications. We examined obesity trends in prevalence, GLP1 use, costs, coexisting conditions, in EMPLOYEES and covered-spouses (Spouses).

METHODS: Retrospective analysis of patients with obesity Dxs (ICD-10=E66.0,E66.01,E66.02,E66.1,E66.2,E66.8,E66.9) and ≥1year of continuous-data post-Dx in Workpartners Research Reference Database (2016—2022) were assigned to annual EMPLOYEE&Spouse cohorts on Dx-year. Analysis focused on annual obesity: prevalence, demographics, obesity- and total-medical-costs, GLP1 and total-drug-costs,% receiving GLP1s and obesity-drug therapy,% undergoing bariatric-procedures,% with type-II-diabetes (T2DM) or sleep apnea Dxs. Analyses also looked at annual trends and those with eligibility continuing GLP1 therapy year-2. Per patient per year costs were adjusted to December-2023 dollars.

RESULTS: Between 2016 and 2022 94,526 patients were initially Dx’d with obesity (EMPLOYEES=63,196; Spouses=31,330), prevalence increased from 4.8%→6.4%. Obese-Dx’d EMPLOYEES (average=45.9 years) were younger than Spouses (Average=48 years) with more women EMPLOYEES (56.6%—60%,Avg=58.4%) than Spouses (61.8%—67%, average=64.8%). GLP1 use increased over time and was higher in EMPLOYEES (3.9%—15.8%) than Spouses (3%—10.9%). GLP1 costs increased for EMPLOYEES&Spouses and were higher for EMPLOYEES ($230→$1147) than Spouses ($152→$796). Total-drug-costs increased (EMPLOYEES=$2,463→$4,011; Spouses=$2,668→$3,934) and total-medical-costs increased (EMPLOYEES=$11,703→$13,988; Spouses=$15,207→$17,894). The % with T2DM and sleep apnea decreased in both cohorts. The % of GLP1 users continuing in year-2 increased from those initially Dx’d in 2016 from 73%→84% in 2022. EMPLOYEE absence costs and days decreased from 2016 to 2021 ($2738→$1168, 9.8→5.3days) and increased in 2022 ($1212, 7.1days) likely reflecting return to work-based utilization.

CONCLUSIONS: Among self-insured employers, the incidence of obesity increased during the study, and is low compared with overall US reports. Higher use of GLP1s are associated with reduced medical costs, and for employees reduced absence costs and time. Further research is needed to determine if those Dx’d are the most severely obese, or randomly represent those seeking treatment.