Obesity Cost Benchmarks
| BMI Category | Prevalence in Workforce | Annual Healthcare Cost Premium | Key Comorbidities |
|---|---|---|---|
| Healthy weight (18.5–24.9) | 35% | Baseline | Low risk |
| Overweight (25–29.9) | 30% | +$500/year | Moderate risk |
| Obese Class I (30–34.9) | 20% | +$1,000/year | Elevated risk |
| Obese Class II (35–39.9) | 10% | +$1,500/year | High risk |
| Obese Class III (40+) | 5% | +$2,500+/year | Very high risk |
The GLP-1 Revolution
GLP-1 receptor agonists (semaglutide — Ozempic, Wegovy; tirzepatide — Mounjaro, Zepbound) are transforming obesity treatment. These medications produce 15–25% body weight reduction — far more than previous weight loss medications. However, they cost $800–$1,200 per month and must be taken indefinitely to maintain weight loss. Employers are grappling with whether and how to cover these medications.
GLP-1 Coverage Strategy
IQ Insight
The GLP-1 coverage decision is one of the most consequential benefits decisions employers face. Covering GLP-1 medications for obesity can cost $3,000–$10,000 per member per year — but may reduce long-term costs through reduced diabetes, cardiovascular disease, and MSK conditions. A thoughtful coverage strategy includes clinical criteria (BMI threshold, comorbidities), prior authorization, and integration with behavioral support programs.