Just how risky is obesity for long-term health? The answer to that question is crucial for decisions regarding the GLP-1 agonist medicines that have revolutionized weight control in the past few years. Some people consider the cost of these drugs exorbitant. After all, they have made the manufacturer of Ozempic and Wegovy very rich. Yet it seems that too often people who need these medicines are being penalized.
Charging More for Health Coverage:
The Affordable Care Act permits employers to charge their unhealthy employees more for health care coverage. But the measures used to determine who has an unhealthy lifestyle include BMI, or body-mass index, as the standard measure of weight for height.
The BMI is used to determine who is considered obese, but it does not actually distinguish those who are out of shape or headed for diabetes from those who are physically fit and metabolically healthy.
Will a High BMI That Qualifies as Obese Tell Who Is Unhealthy?
According to psychologists at UCLA, using a BMI of 30 as the criterion for obesity could misclassify 54 million Americans as unhealthy (International Journal of Obesity, Feb. 4, 2016). What is more, 20.7 percent of those found to have a BMI in the normal range actually had disturbed metabolic markers. As a result, the researchers say, BMI alone should not be used to determine who should pay more for health insurance.
Who Will Continue to Have Access to GLP-1 Drugs?
Part of the reason health insurance is such a hot topic is that premiums will soon increase dramatically. Why are health insurance companies charging so much? Partly, premiums are how they make money. (Another way they make money is through hanging on to those premiums by denying claims, as ProPublica has documented. But that is another story.)
At this time, health insurance companies are struggling with their budgets. The enormous popularity of the GLP-1 drugs such as semaglutide and tirzepatide is a big part of the reason. These weight-loss medications sold under the brand names Wegovy and Zepbound respectively are pricey. Consequently, when large numbers of people take them, insurance companies find their expenses higher than expected. According to STAT, some insurers have already spent more in nine months of 2025 than they did in all of 2024.
Perhaps in response, some employers are considering leaving these meds off the formulary. Certain states have also dropped them from their Medicaid programs. Although most states will still cover semaglutide for diabetes, North Carolina, California, New Hampshire and South Carolina are dropping coverage for obesity treatment. In Michigan, Medicaid will cover GLP-1 obesity drugs only for patients who are classified as morbidly obese. Health plans for state workers are also reassessing coverage of these medicines.
This prospect worries some physicians. Already they are seeing that people with high BMI numbers who had lost significant weight are starting to regain it when their medication is stopped. Along with excess weight come additional health risks, including diabetes, hypertension, cardiovascular disease and kidney problems. Is it penny-wise and pound-foolish to withhold GLP-1 drugs from those who might need them?
