Medication Use for Patients With Obesity: Trends and Characteristics for US Employees

ABSTRACT

Objectives: Obesity has a US prevalence of more than 40% and is associated with many comorbid conditions, posing a significant burden on employers. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are recently available and effective weight loss agents. We examined characteristics and outcomes of employees with obesity and those using vs not using GLP-1 RAs.

Study Design: Retrospective analysis of employee patients in Workpartners Research Reference Database from 2016 to 2023.

Methods: Employees with obesity claims were identified and assigned to annual cohorts based on first year of obesity diagnosis (index). Study employees had at least 1 year of continuous data following their index diagnosis. Annual employee characteristics, comorbidities, absences, disability claims, and direct cost trends were explored for the year following diagnosis. Employees with obesity using and not using GLP-1 RAs were compared on the same metrics. Costs were inflation adjusted to December 2023 US$.

Results: We identified 127,408 employees with obesity. Obesity prevalence increased during the study. Employees with obesity and type 2 diabetes decreased slightly, and other comorbidities were relatively stable during the time frame. Overall, 5.8% of employees with obesity (n = 7359) used a GLP-1 RA. GLP-1 RA use increased annually (3.6% in 2016 to 18.3% in 2023) and accounted for approximately 30% of the cohort’s 2023 pharmacy costs. During the 12-month study period, compared with non–GLP-1 RA users, those using GLP-1 RAs had higher Charlson Comorbidity Index scores (difference = 0.71), higher proportions with all study comorbidities, $11,360 higher direct all-category costs (total medical costs were $12,092 [19.4%] higher), and 0.86 more absence days.

Conclusions: Prevalence of obesity is increasing, and use of GLP-1 RAs as the preferred antiobesity medication has increased as well. The long-term impact of this increased use warrants monitoring and management.

Am J Manag Care. 2026;32(4):238-244. https://doi.org/10.37765/ajmc.2026.89920

Takeaway Points

Obesity poses a significant burden on US employers. We examined employees with obesity between 2016 and 2023 and found increasing use of drug therapies (with 5.8% using glucagon-like peptide-1 receptor agonists [GLP-1 RAs]). Prevalence of obesity and use of GLP-1 RAs gradually increased, type 2 diabetes decreased slightly, and other comorbidities were relatively stable, with GLP-1 RA use representing approximately 30% of the cohort’s 2023 pharmacy costs. Compared with non–GLP-1 RA users, those using GLP-1 RAs demonstrated the following during the 12-month study period:

• Higher Charlson Comorbidity Index scores (difference = 0.71) and proportions with all study comorbidities
• Higher direct costs and more absence days but similar short-term disability days and costs
• The impact of obesity on health care costs is well established. Managing and treating obesity can reduce employer and health plan costs and reduce absences.

Obesity rates in the US are substantial and increasing over time. The CDC reports that between 2021 and 2023, the prevalence of obesity in US adults was 40%, with rates even higher among minority racial/ethnic groups and those with less education.¹ Because obesity (defined as a body mass index [BMI] > 30) is associated with many comorbid conditions, it poses a significant burden on the US health care system, accounting for an estimated 16.5% of all health expenditures.²

Rates of obesity among employed US adults are lower than overall estimates for all adults but follow national trends of an increasing prevalence over time. A recent estimate of civilian employees in the US reported that 30% had obesity.³ Obesity presents unique challenges for employers, as employees with obesity have higher medical costs, disability payments, and work absence and lower work productivity.³

Antiobesity medications (AOMs) combined with lifestyle management interventions have been the standard of care for treatment of obesity for many years, but until recently, these strategies have had limited long-term success in assisting individuals to lose meaningful weight. With the recent FDA-approved expanded indications of several glucagon-like peptide-1 receptor agonists (GLP-1 RAs) for obesity treatment, more effective pharmacotherapies exist.⁴ However, it is unclear how the availability of these more effective GLP-1 RAs is changing characteristics and work-related outcomes of employees with obesity.

To better understand the impact of obesity and use of GLP-1 RAs on employers, we examined a national cohort of employees with obesity, including demographics, medical and pharmacy costs, comorbid conditions, work absences, and short-term disability (STD) days and costs, as well as AOMs including GLP-1 RA utilization and drug-specific costs.

METHODS

This study is a retrospective analysis of the Workpartners Research Reference Database (RRDb), which contains health and work outcomes of US employees from self-insured employers operating in all 50 states from 2001 to present. The RRDb contains claims for more than 3.6 million employees, including medical and pharmaceutical claims, demographics (including race, marital status, job type, exempt/nonexempt status), work absence, and disability claims including duration and payments over a wide range of benefit designs.^5,6

Employee patients were identified as having obesity if they had medical claims with International Statistical Classification of Diseases, Tenth Revision codes for obesity (E66.0, E66.01, E66.02, E66.1, E66.2, E66.8, E66.811, E66.812, E66.813, E66.9) in the 1 to 3 positions from 2016 to 2023. Patients were also included if they were prescribed a drug indicated only for treatment of obesity (orlistat, phentermine, phentermine-topiramate [Qsymia], and naltrexone-bupropion [Contrave]) or a GLP-1 RA (liraglutide [Saxenda], semaglutide [Wegovy], and tirzepatide [Zepbound]), with the first prescription date as the index date for obesity diagnosis. Patients were assigned to annual cohorts based on initial year of obesity diagnosis (index). All patients were required to have at least 1 year of continuous insurance coverage with information available in the RRDb following the initial obesity diagnosis and to be newly initiated on an AOM. There were no preindex eligibility requirements.

For the overall employee cohort with obesity, our analysis focused on annual prevalence, demographics of the cohort, percentage using a GLP-1 RA, total drug costs and GLP-1 RA–specific drug costs, and the percentage receiving GLP-1 RAs and AOMs. The GLP-1 RA group included all medications in that class, including GLP-1 RAs that are indicated for diabetes. We also examined medical comorbidities, both overall by Charlson Comorbidity Index (CCI) scores⁷ and specifically by diagnoses of type 2 diabetes (T2D), cardiovascular disease (CVD), chronic kidney disease (CKD), obstructive sleep apnea (OSA), and metabolic dysfunction–associated steatohepatitis (MASH). Work outcomes including work absences and STD claims were documented. Trends and outcomes were evaluated in the 12 months following the initial obesity diagnosis, indicated by either medical diagnosis or pharmacy claim. The GLP-1 RA cohort was also compared with the non–GLP-1 RA cohort on these metrics.

We assessed medical costs, pharmacy costs, and specific GLP-1 RA drug costs for the cohorts. Costs were the total of patient and insurer payments from paid claims and included patient co-pays. Costs were inflation-adjusted to December 2023 US$ using components of the Consumer Price Index (CPI). Medical costs used the medical cost CPI, prescription costs used the prescription CPI, and all other costs used the general CPI.

The data were analyzed using SAS 9.4 (SAS Institute Inc), Oracle Database 19c (Oracle Corporation), and Python 3.10.12 (Python Software Foundation). For the overall employee cohorts with obesity, annual means and percentages were reported. For the obesity cohort comparisons of GLP-1 RA–prescribed and nonprescribed employees, means, SEs, and statistical significance (defined as level of significance < 5%) were calculated in Python. For continuous variables, 2-sided t tests were used to compare groups. For dichotomous variables, χ² tests were used to compare groups.

Because this was a retrospective database study using deidentified data, institutional review board approval was not required.

RESULTS

Between 2016 and 2023, 127,408 employees were diagnosed with obesity, ranging from 28,237 in 2016 to 9393 in 2023 (Table 1 [A]). Obesity prevalence gradually increased over time, from 11.9% in 2016 to 16.9% in 2023 (Figure). Age at the time of an obesity diagnosis decreased over the study period, and the entire population had a mean age of 44.6 years. Across all the years studied, women made up a larger percentage of the population (56.7%). A total of 71.8% of the employees with obesity were classified as nonexempt (eligible for overtime). Overall, 7359 employees representing 5.8% of employees with obesity were dispensed a GLP-1 RA (Table 1 [B]). Users of GLP-1 RAs were older than nonusers (46.9 vs 44.5 years; P < .0001) and more likely to be female (66.7% vs 56.1%; P < .0001).

Employees with obesity had low CCI scores (defined as 0-2; high defined as ≥ 5),⁷ averaging 0.51 (range, 0.46-0.58) (Table 2 [A]). Prevalence of T2D was 13.5%, reflecting the lower average age of the employee population, and decreased modestly over the time frame (from 16.1% in 2016 to 11.3% in 2023). Rates of CVD (4.4% to 5.3%), CKD (1.4% to 1.7%), OSA (12.4% to 14.7%), and MASH (0.25% to 0.43%) remained stable over time. A mean of 5.9 drug classes was prescribed over each year, and uptake of GLP-1 RAs increased dramatically over study years, from 3.6% in 2016 to 18.3% in 2023. During the study period, those using GLP-1 RAs had higher CCI scores than non–GLP-1 RA users (1.18 vs 0.47; P < .0001) and significantly higher (P < .0001) proportions with all comorbidities evaluated in the study (eg, 54.7% vs 11.0% with T2D and 3.8% vs 1.4% with CKD) (Table 2 [B]).

Most direct costs for employees with obesity were stable over time, with the exception of obesity-specific pharmacy/prescription costs, which had a mean cost of $364 and subsequently increased from $171 in 2017 to $1301 in 2023 (Table 3 [A]). Mean total pharmacy costs over the time period were $2687, with these costs increasing as GLP-1 RA costs rose to nearly 30% of that total by 2023. The work absences and STD of employees with obesity showed small variations over study years, without a consistent pattern.

Compared with non–GLP-1 RA users, those using GLP-1 RAs had $11,360 higher direct costs over all categories, and their total medical costs of $12,092 were 19.4% higher than the $10,130 for employees with obesity not taking a GLP-1 RA (Table 3 [B]). The only nonsignificant difference in direct costs was for obesity-specific medical costs (P = .0669). Absence days were significantly higher for those using GLP-1 RAs. STD days and costs were not significantly different between GLP-1 RA users and nonusers, with only overall STD costs higher for the non–GLP-1 RA users.

Among GLP-1 RA users, those with diabetes vs those without diabetes were older (aged 50 vs 43 years), were more likely to be male (45% vs 20%), had a higher mean CCI score (1.90 [SE = 0.02] vs 0.33), had a higher proportion with CVD (11.89% vs 3.07%), and had higher total cost of care ($28,503 vs $17,823) (eAppendix Table [available at ajmc.com]).

DISCUSSION

Because of the dramatic impact of obesity on work outcomes and employer costs, we leveraged a unique national employee database to examine characteristics and trends among employees with obesity as well as the initial few years of availability of newer and more effective AOMs, focusing on GLP-1 RAs. The Workpartners RRDb includes various US health plans providing employees with a variety of coverage, thus facilitating a broad review.

GLP-1 RAs are expensive, and coverage remains limited under many insurers⁸ and most large employer firms.⁹ A survey of larger employers by the Business Group on Health found that only 67% were covering GLP-1 RAs indicated for the treatment of obesity.¹⁰ After initially providing coverage, several commercial insurers and employer purchasers rescinded GLP-1 RA coverage for weight loss.¹¹ A June 2024 analysis found that less than 1% of plan formularies on the Affordable Care Act (ACA) marketplace include drugs solely approved to treat obesity and that 86% and 96% of ACA plans require prior authorization and include quantity limits, respectively.¹² A 2025 Institute for Clinical and Economic Review report noted that some purchasers and insurers limit GLP-1 RA use to a single agent and may require step therapy.¹¹

We found that the use of GLP-1 RAs as AOM is increasing significantly among employees with obesity. Additionally, those using GLP-1 RAs had significantly higher CCI scores during the study period than those not using GLP-1 RAs. The lower scores in non–GLP-1 RA users reflect their lower incidence of medical comorbidities.⁷ Conversely, GLP-1 RA users had more comorbidities, including a higher proportion with comorbidities known to benefit from GLP-1 RAs, such as sleep apnea, CVD, and CKD. As expected, the pharmacy costs were much higher in this group because GLP-1 RAs are significantly more expensive than the other AOMs. Although obesity-specific costs may be driving the increases in overall prescription costs of employees with obesity, the higher rate of comorbidities among GLP-1 RA users may be responsible for their $6169 higher prescription costs. Among GLP-1 RA users who did not have diabetes, we found that they were mostly female and younger and had lower CCI scores and CVD rates. This is consistent with prior research on GLP-1 RAs used for obesity, suggesting that usage rates are likely to increase in the future.^13,14

Rates of obesity more than doubled in both men and women from 1990 to 2021, with 2021 prevalence rates of 41.5% and 45.6%, respectively. By 2050, the prevalence of obesity is predicted to be 58.8% for women and 55.3% for men.¹⁵ Obesity rates among actively employed individuals are lower than among the overall adult population in the US.³ Among nonfarm civilian employees, the prevalence of obesity is reported to be 30%, with an additional 34% of these employees classified as overweight (BMI of 25-30).³ The present study found increases in the rate of obesity diagnosis and GLP-1 RA use and a shift toward a younger age group with lower CCI scores being prescribed GLP-1 RAs. These changes may be related to the availability of GLP-1 RAs, insurers’ prior authorization requirements for a diagnosis,^10,12 and more patients seeking treatment because of publicity and advertising for GLP-1 RAs. This trend is likely to have a significant budget impact on insurers, especially self-insured employers. The effectiveness of GLP-1 RAs and the availability of oral routes of administration are likely to further the paradigm shift in obesity management. We found that less than 10% of employees with obesity use other AOMs. But the trend of AOM use overall is increasing and likely to accelerate as more GLP-1 RAs and glucose-dependent insulinotropic polypeptide medications are approved.¹⁶

The impact of obesity on health care costs is well established. According to the CDC, in 2019, annual medical costs for adults with obesity were $1861 higher than for individuals with normal weight.¹⁷ These increased costs reflect greater risk among those with obesity for medical comorbidities, including hypertension, heart disease, high cholesterol, diabetes, CKD, asthma, sleep apnea, osteoarthritis, gout, nonalcoholic liver disease, gastroesophageal reflux disease, and some cancers.¹⁸

The impact of obesity in the workplace is likewise well established. In an industry-sponsored report, additional annual per-patient medical costs for employees with obesity were $1514, with $664 higher disability costs, $112 higher injury worker compensation, $1755 higher absenteeism costs, and $2427 additional costs resulting from lower productivity.³ Although imputed presenteeism and absenteeism costs may be subject to debate, it is accepted that these costs are not nominal. As such, obesity poses a significant concern for employers and insurers. Although we did not find statistically significant differences in work outcomes between employees with obesity using GLP-1 RAs and employees with obesity not using GLP-1 RAs, this may be related to study design and the 1-year follow-up period. Future research should consider matching or regression adjusting the outcomes based on demographic differences and longer observation periods.

Weight loss among patients with obesity is associated with lowered health care costs. A recent analysis using data from the Medical Expenditure Panel Survey reported that among Medicare patients who lost 5% of their weight, annual health care costs were lowered by $1262; patients achieving a 25% weight loss reduced health care spending by $5442.¹⁹ Among adults with commercial insurance, a 5% weight loss and 25% weight loss were associated with $670 and $2849 lower annual health care costs, respectively.¹⁹ Another study among commercially insured patients documented 33% lower health expenditures among employees who lost 15% or more of their weight compared with a 10% reduction in a control group that lost less than 5% of their weight.²⁰ Although neither study evaluated patients who specifically used GLP-1 RAs to lose weight, results are in line with an industry-sponsored simulation study that estimated cost savings among patients achieving a 25% sustained weight loss using GLP-1 RAs to be $4830 per person over 5 years and $13,510 over 10 years.³

GLP-1 RAs have been shown to be very effective in weight loss, and newer-generation agents, including combination therapies with GLP-1 RAs, in the pipeline might further revolutionize the management of obesity.²¹ The cost-effectiveness of GLP-1 RAs for weight loss has not been well established, with economic modeling studies showing cost-effectiveness ratios beyond the threshold of $100,000.²² There are also challenges with access, adverse effects, and discontinuation that could impact the potential long-term benefit of GLP-1 RAs for weight loss.^13,23 Although not a focus of the current research, a subanalysis of persistence on a GLP-1 RA found it to be surprisingly high, with 78% overall continuing the medication in the year following the index year.²⁴ Future studies are warranted to understand GLP-1 RA persistence and adherence and the economic impact of GLP-1 RAs as effective tools for managing weight loss among employees.

The RRDb is a national database covering a diverse array of regions and job types, including a variety of health plans and coverage types, and is not limited by individual plans’ formulary restrictions or prior authorization requirements. The database’s design allows linkages between clinical information and work outcomes, and the tracking by employee allows analyses over time including in situations where employees may change insurers. The outcomes are not subjective or impacted by employee recall, as opposed to a subjective survey-based approach. The protocol requirement of both an obesity diagnosis and prescription for a GLP-1 RA indicated for obesity does not exclude off-label use of diabetes-indicated GLP-1 RAs for weight management before obesity-specific GLP-1 RAs were approved. We do note that a diagnosis of diabetes was significantly higher in patients using a GLP-1 RA (Table 2 [B]).

Limitations

Several limitations of our study warrant acknowledgment. Most importantly, there is uncertainty around the indication of the prescribed GLP-1 RAs. Although all patients needed an obesity diagnosis or an obesity-specific medication prescription to be included in this study, we do not know the indication for prescribed GLP-1 RAs. It is possible that patients were prescribed GLP-1 RAs indicated for diabetes for obesity, diabetes, or both. In addition, employees with obesity were likely underdiagnosed and may only represent employees who sought AOM treatment that was captured in claims data. Clinicians might not assign a diagnosis if not relevant to the reason for a medical encounter. Studies have shown that clinicians infrequently enter obesity diagnoses for patients with BMIs exceeding 30, with documentation rates ranging from 5.6% to 30%.^25-27 Because administrative claims data do not often include weight or BMI, it is likely that some patients with obesity were missed. This may account for our overall 16.9% obesity prevalence, which is significantly less than in subjective surveys of obesity among employees that report rates of 30%.³ Additionally, it is possible that some patients were overweight (but not meeting criteria for obesity) and may have been candidates for AOMs due to certain comorbidities and were not accounted for. In general, administrative data include the risk of clerical inaccuracies, recording bias secondary to financial incentives, and temporal changes in billing codes. Also, the RRDb may not be reflective of all employees, as these administrative claims data were derived from US employees with commercial health insurance and do not include government or exchange plans. Furthermore, our study did not include a preindex requirement, and some employees’ first identified diagnosis of obesity may be due to their addition to the database and not a new diagnosis. Although we relied on dispensed prescriptions for GLP-1 RAs, it is unknown whether the employees took and were persistent with their medications. During the study time frame, the FDA reported drug shortages of liraglutide (first reported 7/18/2023) and semaglutide (first reported 3/31/2022), which may have impacted adherence and costs.²⁸ Finally, the presence of the COVID-19 pandemic during the study time frame may have an unknown impact on our findings due to reduced access to clinicians.²⁹

Future research should explore the impact of GLP-1 RAs on medical costs over time. Specifically, benefits of sustained weight loss over years may result in improved clinical outcomes, greater work productivity, and lower total costs not seen in a short-term study such as the one presented in this article. In addition, the correlation between age and disease prevalence among employees would be insightful.

CONCLUSIONS

This real-world health claims database study showed an increase in the prevalence of obesity and the use of GLP-1 RAs among employees of self-insured employers. The impact of obesity on health care costs is well established, and weight loss among patients with obesity is associated with lowered health care costs. We found that the costs of GLP-1 RAs are driving increases in direct prescription costs; however, these agents have the potential to lower medical costs but may require longer follow-up to see those savings. Strategies should be sought to identify the employees most likely to tolerate, benefit from, and be persistent with GLP-1 RA therapy.

Author Affiliations: Insurance Services Division (CBG) and Center for High-Value Health Care (SKP), UPMC Health Plan, Pittsburgh, PA; Workpartners, LLC, Loveland, CO (IAB), and Pittsburgh, PA (EMR); Better Health Worldwide, Inc (RAB), Newfoundland, NJ.

Source of Funding: None.

Author Disclosures: The authors report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.

Authorship Information: Concept and design (CBG, IAB, RAB); acquisition of data (RAB); analysis and interpretation of data (CBG, IAB, EMR, SKP, RAB); drafting of the manuscript (CBG, IAB, SKP, RAB); critical revision of the manuscript for important intellectual content (CBG, SKP, RAB); statistical analysis (IAB, EMR); provision of patients or study materials (IAB, EMR); and supervision (EMR, RAB).

Address Correspondence to: Richard A. Brook, MS, MBA, Better Health Worldwide, Inc, 18 Hirth Dr, Newfoundland, NJ 07435-1710. Email: rich@bh-ww.com.

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