WorkCompWire
Full article on: workcompwire.com
Michael Choo, MD
Chief Medical Officer, Workers’ Compensation, Paradigm
As obesity continues to be a significant public health concern in the United States, the workers’ compensation system is increasingly grappling with its impact on workplace injury risk, management, and recovery. A recent and noteworthy example is the growing interest in novel anti-obesity medications, specifically Glucagon-Like Peptide-1 (GLP-1) agonist medications, within our industry. With utilization for this class of drugs—which includes medications such as Wegovy® and Mounjaro®—skyrocketing in the general health system, questions and concerns on their usage and potential benefits in work-related claims have also seen a sharp uptick.
Even as a relatively new treatment without long-term studies, many stakeholders have recognized the possibilities of GLP-1s and similar gut-hormone agonists for addressing the higher costs, increased disability risks, and prolonged recovery periods associated with workplace injuries confounded with comorbid obesity. However, to make informed and effective decisions, it’s important to understand the known short-term and long-term outcomes, costs, and side effects of GLP-1s, in the context of the broader array of obesity management options available, especially those that lead to durable lifestyle modifications involving nutritional, behavioral, and physical interventions with proven health benefits.
The impact of obesity on injury risk and recovery
Obesity has a significant impact on both the health of the workforce and the cost of workers’ compensation. In the U.S., more than two out of five adults meet the guideline for obesity, increasing their risk of chronic conditions like heart disease and diabetes—and their likelihood of workplace injuries.1 A Duke University study found that workers with obesity are twice as likely to file a claim, likely due to increased incidents such as slips, trips, falls, and lifting-related injuries.2 Excess weight can also exacerbate injuries, particularly those involving the spine and musculoskeletal system.
From a claims perspective, obesity is associated with higher medical costs, longer recovery periods, and increased risk of disability. The same Duke study found that obese workers experienced more than 13 times the number of lost workdays due to injury. These challenges are compounded by obesity-related comorbidities such as diabetes and cardiovascular disease, which also exacerbate inflammation in the body. Together, these factors complicate recovery and place greater demands on claims management, highlighting the importance of tailored strategies for this high-risk population.
Obesity care strategies: More than just GLP-1s
To mitigate these risks and liabilities, the workers’ compensation system must adopt a comprehensive approach to managing risks and providing care for obese workers. While GLP-1s are one tool, many other strategies may be just as effective, depending on what’s best for the individual and their recovery goals. For example, losing weight to be cleared for surgery may take one approach, while managing obesity to prevent future complications like diabetes versus those already with diabetes-related comorbidity may call for another. Effective weight loss interventions encompass educational and activity-based strategies designed to support injured worker engagement and long-term weight management.
Obese injured workers requiring more intensive support can benefit from certain structured and medically supervised pathways to weight loss. Common options include inpatient weight loss programs that offer comprehensive medical, nutritional, and psychological support, as well as bariatric surgical options such as gastric bypass or sleeve gastrectomy, which can help ensure significant and sustained weight reduction for eligible patients.
The GLP-1 discussion—understanding effectiveness and side effects
Pharmaceutical interventions like GLP-1s have grabbed headlines and played an increasing role in modern weight loss treatment with their efficacy in appetite suppression and metabolic regulation. Nevertheless, these medications have an associated range of side effects, complications, and risks that require a sound understanding of how they work and the importance of proper oversight. Remember that GLP-1 medications are lifelong treatments and not a cure.
At Paradigm, our early case data reveals that the use of GLP-1 medications is trending higher, with 1% of our catastrophically injured worker cohort utilizing GLP-1 medications in 2020, versus 5% in 2024.3 Although the majority have been prescribed for existing diabetes conditions, we are observing some for obesity treatment as well. We are closely monitoring and tracking the impact of GLP-1 medications on our clinical outcomes as we anticipate a steady growth in the number of injured workers with anti-obesity medications over the coming years.
It is critical to balance the positive benefits with a clear appreciation for the potentially serious side effects of these drugs, as well as their high costs—typically $1,000 to $1,500 per month according to a SHRM report.4 Side effects of GLP-1s are not fully understood, but documented near-term common side effects include nausea, vomiting, diarrhea, abdominal pain, dehydration, and constipation. In my own experience as an Emergency Medicine Specialist, I’ve seen multiple issues related to this class of drugs, with not only the aforementioned gastrointestinal issues, but also conditions that required admission to the hospital with pancreatitis, severe dehydration, induced renal failure, and gallbladder dysfunction. There have also been documented cases with vision impairments/vision loss from worsening diabetic retinopathy as well as optic neuropathy.
From a surgical standpoint, the current guidance is to hold these medications before undergoing surgery due to potential complications related to anesthesia, such as aspiration and regurgitation. Finally, the long-term side effects are still unknown due to the novelty of GLP-1 receptor agonist medications, and there is a concern for increased risk for thyroid cancer that should be considered by those individuals with a history of thyroid cancer and other multiple endocrine neoplasia conditions.
Obesity risk management is a team effort
Ultimately, any effective strategy will require a collaborative approach and effective alignment of incentives. First and foremost, healthcare providers play a crucial role in guiding and supporting the weight loss efforts of injured workers. This influence includes the need for clear, empathetic communication and evidence-based recommendations to enhance patient engagement, adherence, and compliance.
Legal professionals, claims professionals, and clinicians need to work together to identify potential adverse reactions to these medications and ensure patient safety through active monitoring. Because long-term side effects are still being studied, stakeholders across the system face a multitude of uncertainty—from care decisions to liability and payment responsibilities.
Obesity in workers’ compensation is a concern that requires serious attention and support. And despite the costs and side effects, there is some promise for the role GLP-1 medications may play as part of a broader weight management strategy for workplace injury recovery. But, as with any new therapy, we should all continue to closely monitor its impact and discuss how to keep uncovering and disseminating the benefits and risks associated with this novel intervention—to facilitate achieving the best possible outcomes for our injured workers.
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