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Posted by Simon Pagé, ASA, AICA, February 21 2024
Health Insurance
Obesity: a Chronic Illness


Obesity is gaining ground in North America, and Canada is no exception. Besides leading to serious health problems, obesity also affects productivity at work. Considered a chronic illness, it can be treated with a multidisciplinary approach that includes innovative drugs. While they can contribute to improved health, these medications can also significantly increase the cost of private drug insurance plans.

Today, roughly 1 in 4 adults and 1 in 10 children are living with obesity in Canada. If nothing changes, experts predict that the obesity rate will reach nearly 30% by 20301

Persons suffering from obesity are also more likely to develop other serious illnesses, such as diabetes, hypertension and high cholesterol. According to a study by the Canadian Cancer Society, obesity will soon become the second-leading cause of cancer after smoking1

Obesity also impacts productivity at work and can lead to fatigue, exhaustion, difficulty concentrating, absenteeism and presenteeism. This is before even considering the associated prejudice and stigma that can affect the mental health of individuals living with obesity. 

Obesity Can Be Treated 

Long considered strictly a result of lifestyle choices, obesity is now considered a chronic illness, which allows for an updated perspective. 

Combining treatments and medications with healthier living habits provides the potential for more sustainable results.  

Also known by its generic name “semaglutide”, Ozempic is approved by Health Canada for the treatment of type 2 diabetes. Due to the fact that it acts on blood sugar levels and reduces appetite, it also has weight loss properties. For this reason, some doctors prescribe it to treat obesity, leading to it being the top traditional drug by overall spending for private drug plans in both 2021 and 20222

Faced with this situation, several insurers implemented cost containment measures such as prior authorization and step therapy to ensure optimal drug cost control and make sure the person is taking the right treatment at the right time for its condition. 

There are other weight loss medications offered in Canada, including ContraveR, SaxendaR and XenicalR. Others, like Wegovy, have been approved by Health Canada but are not yet commercially available. 

Obesity and Group Insurance 

Obesity treatment is introducing a new paradigm for insurance plans. Since obesity was historically classified as a ‘lifestyle choice,’ most plans did not cover drugs for this condition. Now that obesity is recognized as a chronic illness and treatments have been developed, perceptions tend to evolve. We are increasingly aware of obesity comorbidities, conscious of its impact on those who experience it and their productivity at work, and aware of its costs for employers and employees alike.  
Many employers have reconsidered their position on covering weight loss drugs because they understand that by helping people suffering from obesity, they will improve the overall health of their workforce, reduce their healthcare spending and contribute to enhanced work performance. 

Fostering a Multi-Pronged Approach 

Effective weight management programs combine lifestyle changes, medications, workout devices, surgery and psychosocial support to address the underlying factors of weight gain. 

Many Canadian provinces and several organizations (such as Obesity Matters) are investigating this new reality and agree on the need to create an adequate treatment infrastructure emphasizing total health instead of focusing solely on weight loss. Information is still preliminary on many aspects of this issue, hence the importance of identifying and carefully analyzing all existing and future data. 

As our approach to obesity and weight management is evolving, employers are increasingly supporting affected employees with benefits plans that cover weight loss treatments. This contributes to a more positive and efficient work environment, in addition to being an excellent equity, diversity and inclusion (EDI) initiative for employers. 

The Right Treatment for the Right Person at the Right Time! 

One thing is certain: before prescribing an anti-obesity treatment, doctors must discuss the lifestyle choices of their patients, check their personal or family medical history, determine their body mass index and ensure there are no potential complications due to existing comorbidities. In short, each individual must receive appropriate treatment to achieve positive and sustained results. 

If you or anyone you know is looking for more information about obesity and how it impacts drug insurance plans, the experts at AGA Benefit Solutions would be happy to discuss this further. 

1 Obesity and excess weight: It’s time to act! | Desjardins Insurance
2 How plan sponsors, insurers are considering coverage of weight-loss drugs amid rising use of Ozempic | Benefits Canada 

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Simon Pagé has gained more than 10 years of consulting experience in meeting employers’ needs, developing his ability to guide and advise employers on defined contribution pension plans, investment and group insurance. His consulting style is characterized by his efficiency, leadership and integrity, and his ability to communicate clearly on complex issues.
Simon Pagé, ASA, AICA