A piece of the puzzle: GLP-1s in a cardiometabolic strategy  

Long viewed as a matter of personal responsibility rather than as a medical condition, obesity was reframed in 2025 by the Lancet Diabetes and Endocrinology Commission as a chronic, systemic disease. For employers, the rise of GLP-1 medications as a treatment option for obesity — and their significant cost — has focused attention on the potential of these medications to manage cardiometabolic conditions as well. Obesity significantly raises the risk of chronic health issues such as type 2 diabetes, hypertension, and an underdiagnosed condition called metabolic dysfunction-associated steatohepatitis. According to the CDC, about 15% of U.S. adults have diabetes, and nearly half (48%) have heart disease. Given that these conditions diminish quality of life and drive significant costs, and, addressing obesity as part of a comprehensive cardiometabolic strategy can make a real difference for both employers and employees and their families.

Reevaluating cardiometabolic resources

As employers look to control GLP-1 spending, it’s important to consider the bigger picture. Rather than focusing solely on obesity, reassessing current cardiometabolic resources can help improve support for the full spectrum of related conditions. Evidence-based cardiometabolic care includes lifestyle interventions, pharmacological treatments, and surgical options. Many employers are exploring ways to gradually expand these interventions as part of their overall strategy.

Key areas to evaluate include:

Coverage gaps. Do your health plans cover nutrition counseling, medical nutrition therapy, and musculoskeletal therapy to address issues that lead to sedentary behavior? Review the benefits available to support members at all levels of condition severity, including prediabetes, hypertension, and diabetes management. Coverage for bariatric surgery provides an important option for some members struggling with obesity. If GLP-1 coverage for weight loss is offered, pairing it with lifestyle support through vendors aligned with best practices can improve outcomes. If you don’t cover GLP-1s through the medical plan, consider offering self-pay access.

Workplace environment and social determinants. The workplace environment plays a crucial role in cardiometabolic health by providing access to healthy food and encouraging physical activity. Reducing the availability of high-fructose corn syrup or artificially sweetened beverages and ultra-processed food snacks, while increasing healthy food options where food service is available, can support healthier choices. Additionally, considering employees’ social determinants of health, such as access to safe walking areas, affordable nutritious food, and transportation or time off for preventive care, can help remove barriers to effective weight and condition management.

Behavioral health and sleep support. Expanding access to behavioral health support is essential, as individuals with obesity often face higher risks of depression and anxiety. Programs that promote sleep health are also important, since poor sleep can worsen cardiometabolic health and obesity. Conversely, obesity-related conditions like obstructive sleep apnea can disrupt sleep quality.

Optimizing GLP-1 use

If your comprehensive strategy does include GLP-1 coverage for weight management, or if you are considering adding coverage, key questions are how to cover these medications to maximize clinical benefit and value while managing overall spend. There are several important considerations in structuring this benefit:

First, real-world data show high discontinuation rates for GLP-1s, often due to side effects or other challenges, before full benefits are realized. Prescription management, dosing optimization, and patient support can help patients manage side effects and continue treatment. Tracking patient response ensures that GLP-1 prescriptions continue only for those who gain meaningful benefit.

Second, even when patients meet FDA criteria for GLP-1 use, it may not be the best treatment option. A holistic evaluation and shared decision-making with the patient will determine the most appropriate weight-management approach. Typically, a closed network of providers committed to this whole-person approach is needed to optimize GLP-1 prescribing.

Finally, if broad GLP-1 coverage is not feasible, prioritizing coverage for individuals with high severity (BMI over 40) or those with comorbidities and risk factors can be a practical starting point. Limiting coverage to a smaller eligible group could offer a financial benefit, or at least break even, compared to offering broader coverage.

Conclusion

Addressing cardiometabolic conditions can start with GLP-1 medications, but ideally it should not end there. Treating obesity and related conditions requires a multi-tiered approach that can be developed over time. Employers that prioritize cardiometabolic health as a business strategy will find that GLP-1s are just one piece — though potentially a key piece — of a larger puzzle.