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GLP-1s are transforming obesity care, and the decisions plan sponsors make will impact their organizations for years to come
Daniel Cusator, MD, MBA, Account Medical Director, Blue Cross Blue Shield of Tennessee
Shane Lipp, Senior Benefits Manager, Synovus
Claire Morrow, PT, DPT, OCS, FAAOMPT, Physical Therapy Consultant Senior Manager, Hinge Health
Charlie Smith, MD, Chief Medical Officer, AON
Gabrielle Boisvert, Head of Solution Strategy, Teladoc Health (Moderator)
In 2021, it was the beginning of the widespread, mainstream use of GLP-1s for weight loss. Before we knew it, our understanding of obesity and how it’s treated changed dramatically thanks to breakthrough treatments and extensive research.
The prevalence of obesity continues to rise, and GLP-1 coverage has become a top cost driver for organizations. In the middle employer and health plan leaders tasked with developing a benefits strategy that satisfies high demand from people they serve without impacting the bottom line. At Forum 2025, industry leaders shared their perspective on where obesity care is today—and what to consider for the future.
Obesity is more than just BMI or a number on the scale. “Obesity is an indicator that a person’s metabolism is dysfunctional,” Dr. Daniel Cusator said.
This highlights bigger health issues. Dr. Cusator said obesity signals someone who’s at risk because their insulin levels are elevated, which is associated with early inflammation and severe disruption of normal immune function. He said this correlates to rising rates of cancer and autoimmune conditions.
Working with employer clients of Blue Cross Blue Shield of Tennessee, the focus has shifted to proactively addressing the root causes of obesity. Independent of the use of weight loss drugs, he said this means supporting people with behavior change, specifically nutrition, activity and behavioral therapy.
Obesity is associated with more than 200 diseases, including musculoskeletal (MSK) conditions. For MSK, the connection goes beyond the excess burden on weight-bearing joints. “People with obesity have higher rates of osteoarthritis in non-weight-bearing joints like the wrist and hand,” she said. “It speaks to a systemic inflammatory process.”
As the Chief Medical Officer at AON, Dr. Charlie Smith advises a lot of employers on their benefits and GLP-1 coverage strategies. “We have quite a few employers who have delayed locking in their plans,” he said. “I’ve never seen benefit decisions go this way.”
Dr. Smith said GLP-1 coverage among their clients is split, and that there’s more engagement at the C-suite level as organizations weigh cutting other benefits or raising premiums to cover the cost of coverage.
Synovus, a financial services company headquartered in Georgia, does offer GLP-1 coverage for its 5,000 employees. Shane Lipp said they’ve partnered with Teladoc Health and that employees must meet specific criteria for coverage. “It was a demand from our team members,” he said. “As a company, we were determined to find a way to make it work.”
In a Teladoc Health consumer survey, 83% of people potentially eligible for a GLP-1 said they would consider it. Highlighting the demand, most said they would be willing to share or cover the cost of a GLP-1 as part of a virtual care program.
Lipp said covering GLP-1s has had a positive impact on retention. For many organizations, this is a crucial factor.
An AON study of 140,000 patients on GLP-1s found there was a 44% decrease in cardiovascular events, among other benefits. This could mean long-term financial benefits for organizations, Dr. Smith said. “If employers are seeing a lot of turnovers in two years, it’s a tough decision,” he said.
More GLP-1 news is on the horizon. With new indications and oral versions coming, plan sponsors will be faced with more important decisions related to coverage and obesity care programs. “We’re going to see utilization go way up,” Dr. Smith said.
With that in mind, how can patients be better supported? “I’d like to see more collaboration between a patient’s care providers,” Dr. Morrow said. “For people using a GLP-1 for their weight loss journey, including physical therapists to regain or maintain muscle mass can help with long-term changes.”
According to Lipp, Synovus has focused on removing barriers. “There’s proper criteria in place [for GLP-1 coverage],” he said. “At the same time, those who need access can get them.” To avoid financial barriers, Synovus offers the Teladoc Health lifestyle management program at no cost to its employees.
Dr. Cusator said studies of comprehensive lifestyle management programs for people on GLP-1s have been encouraging. Several studies have even shown that people titrating off GLP-1s and maintaining lifestyle changes have been able to keep the weight off. “They should be a prerequisite before people start medications, then used concurrently with medications,” he said. The challenge is getting continued engagement.
“So far we’ve seen in Teladoc Health data that engagement in our lifestyle management program is really good,” Gabrielle Boisvert said. When people have easy access to valuable resources like food logging or registered dietitians, they’re motivated, she said.
Whether or not GLP-1s are part of the treatment plan, the focus needs to remain on supporting patients with meaningful, long-term behavior change. “The fundamental treatment of root causes and behavior modification is always the right choice,” Dr. Cusator said.
With that in mind, how can patients be better supported?
