As benefits leaders navigate obesity-related costs, the conversation often centers on GLP-1 medications. But to find a sustainable solution, it’s important to look at the data supporting bariatric surgery as a superior, long-term intervention.
We spoke to Dr. Jason Tibbels, Chief Medical Officer at Lantern, and Dr. Raymond Hwang, Associate Chief Medical Officer at Lantern, to cut through the noise and provide an educational, easy-to-understand comparison of treatment options.
Understanding the Financial Impact of Obesity for Employers and Unions
Q: How is obesity impacting healthcare spending today?
Dr. Tibbels: It’s a major cost accelerator, both directly and indirectly. While GLP-1s drive pharmacy costs (sometimes up to 10% of annual claims), obesity fundamentally drives chronic diseases like heart issues and cancer.
Dr. Hwang: A recent study found the cost of obesity and being overweight was $425 billion in 2023. The annual cost per worker with obesity was nearly $6,500, including everything from more sick days to higher workers’ comp claims. If you have 1,000 employees, roughly 30% will be obese. You’re looking at nearly $2 million annually in obesity-related costs alone, and that number is growing over time.
Q: How did employers or unions address obesity in the past?
Dr. Hwang: In retrospect, we were somewhat naive about this for decades. Most of us thought we could wellness-program our way out of obesity. The playbook was basically:
- Offer health screenings, hopefully catch their BMI during annual checkups
- Offer gym memberships (that most employees never used)
- Provide educational materials about nutrition and movement
Not surprisingly, this fell short. When it came to coverage, most employer health plans either flat-out excluded bariatric surgery or made it so restrictive that very few could access it.
“Most of us thought we could wellness-program our way out of obesity.”
Q: How are employers and unions addressing obesity today?
Dr. Tibbels: Today, it’s a mix of GLP-1 coverage, broader behavioral and nutritional support, and steering to Centers of Excellence for surgery and comprehensive programs. Care navigation to high-quality bariatric surgeons is now mainstream.
Dr. Hwang: More are covering GLP-1s, but a lot of employers are discovering it’s not the silver bullet many hoped it would be. Many more understand obesity is a chronic disease and are looking at comprehensive solutions. They’re taking a more strategic, evidence-based approach.
Comparing Bariatric Surgery and Medications (GLP-1s) for Employers
Q: Why should employers and unions offer bariatric surgery, even if they already cover GLP-1 medications?
Dr. Tibbels: Employees need access to the most effective, durable treatment options. Not offering bariatric surgery is denying access to one of the most effective interventions in obesity and metabolic medicine.
Bariatric surgery is a highly effective and durable intervention for both weight loss and treating associated chronic conditions.
“Bariatric surgery is a highly effective and durable intervention for both weight loss and treating associated chronic conditions.”
Q: How does the effectiveness of bariatric surgery compare to GLP-1s?
Dr. Tibbels: Surgery provides greater, more lasting weight loss for most patients. Typical outcomes are approximately 30% total weight loss at year one, with about 25% maintained at 10 years for gastric bypass/sleeve.
In contrast, GLP-1s like tirzepatide average approximately 22% total weight loss around 18 months, and weight often returns when they stop taking medication. Most patients discontinue GLP-1s within a year. There’s a place for both, but you can’t rule out surgery.
Dr. Hwang: A recent head-to-head study showed bariatric surgery delivers about five times more weight loss than GLP-1s over two years. That’s a substantial, potentially life-changing weight loss compared to a modest improvement.
As Dr. Tibbels mentioned, most patients don’t stay on GLP-1s long-term. Patients regain one-half to two-thirds of their weight within one year after they stop taking the medication. Weight loss from bariatric surgery tends to be permanent.
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Q: Which is more financially sustainable in the long run?
Dr. Hwang: Surgery, despite a higher upfront cost, often becomes more cost-effective due to its long-term durability. Over five or 10 years, surgery quickly becomes more cost-effective. This is because maintaining weight loss with GLP-1s can cost over $800 per month, every month, indefinitely.
More importantly, patients who have a successful bariatric surgery often see improvement in other costly comorbidities such as diabetes, hypertension, sleep apnea, etc., which leads to improved overall health and further cost reductions.
The Benefits of Bariatric Surgery for Employees and Union Members
Q: How have bariatric surgery guidelines changed, and what does this mean for Lantern members?
Dr. Tibbels: Eligibility is now much broader, meaning more people can benefit. The 2022 ASMBS/IFSO guidelines modernized eligibility:
- Surgery is recommended at a BMI ≥35 regardless of comorbidities.
- Consider surgery at BMI 30–34.9 when metabolic disease is present or other therapies haven’t worked.
- Appropriate adolescents can be candidates.
- Also, lower BMI thresholds for some Asian populations due to risk at lower BMI.
As a result, more people qualify. The “try and fail everything first” is no longer the rule.
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Q: How does bariatric surgery improve quality of life beyond the scale?
Dr. Hwang: Improvement in chronic conditions is where savings accumulate: For example, bariatric surgery can often cause remission of type 2 diabetes, obviating the need for medication to control blood sugar. Healthier employees and union members—who are no longer struggling with sleep apnea or joint pain—are happier and more productive.
Q: Why do some employers and unions make bariatric surgery mandatory through quality-focused partners like Lantern?
Dr. Tibbels: It’s about ensuring the best possible outcomes and avoiding complications. They want assurance that members are seen by the most experienced surgeons. Providers in our network go through a vigorous vetting process. It’s critical to deliver the highest-quality care, the best outcomes, and because we contract directly with providers, we deliver cost savings.
Educating Your Employees and Union Members about Bariatric Surgery
Q: How can benefits leaders educate employees and unions members about options to treat obesity?
Dr. Hwang: Remove the stigma and treat obesity like any other chronic health condition. Educate your employees or union members by:
- Hosting information sessions that compare all treatment options using real, evidence-based data.
- Addressing the misconception that surgery is dangerous or experimental, highlighting its decades of refinement and safety.
- Focusing on the durability and sustained quality of life offered by surgery.
- Informing them about all of your benefits programs offered to help treat obesity and reinforce the message throughout the year.
