A new research article from the Reinsurance Group of America (RGA) notes that treating obesity as a medical condition represents a paradigm shift in healthcare.

“The emergence of anti-obesity therapies, combined with growing evidence of mortality and morbidity reductions from weight loss, signals a new era that requires careful consideration by insurers for risk assessment and underwriting decisions,” they write in the report, Reframing Obesity as a Treatable Condition. 

In addition to exploring obesity as a condition, it examines the benefits of weight loss and the limitations of lifestyle interventions. It notes that obesity rates tripled between 1975 and 2022.

The biology of obesity is discussed at some length: “Because fat cannot be redistributed from visceral adipose tissue (VAT) to subcutaneous adipose tissue (SAT), once VAT reaches its storage limit, excess fat begins to accumulate in organs and tissues that are typically lean,” they write.

“Beyond the damage caused by ectopic lipid accumulation (lipotoxicity), the ectopic fat deposits themselves secrete additional inflammatory adipokines, contributing to local organ injury and elevated cardiovascular risk.” Multiorgan dysfunction, liver diseases and kidney disease are all also discussed.

Cardiometabolic morbidity and mortality 

“From an insurance perspective, the most significant impact of cardiometabolic syndrome (CMS) is its strong association with cardiovascular morbidity and mortality. The phrase ‘systemic disorder leading to multiorgan dysfunction’ highlights the broad health consequences of CMS.” These include the development of hypertension, prediabetes, respiratory disease, dementia, obstructive sleep apnea, obesity-related cancers and more.

The paper notes that cardiometabolic risk factors begin to improve with even modest weight loss. “A five per cent reduction leads to a significant improvement in insulin sensitivity in both liver and adipose tissue, while a greater loss of 11 per cent to 16 per cent is needed to significantly improve muscle insulin sensitivity. Inflammatory markers do not tend to improve with a five per cent weight loss but do show meaningful reductions with a 11 per cent to 16 per cent weight loss.” Similar improvements in fasting blood glucose, triglycerides and blood pressure are also discussed.

“For insurers, factors like access, adherence and long-term outcomes will make the insurance impact (of anti-obesity medications) more nuanced,” they write. “In addition, the accurate risk assessment of individuals who are taking new GLP-1 therapies will require expert underwriting consideration.”