Weight loss decisions, like many aspects of personal health, are deeply individual and should be considered carefully based on one’s specific circumstances. For some, the recent rise in popularity of GLP-1 medications for weight loss has sparked considerable debate, both in terms of effectiveness and potential side effects. This article delves into the pros and cons of these drugs, shares personal experiences, and examines their growing role in insurance plans.
For many people, New Year’s resolutions carry a certain stigma. But for me, it wasn’t the turning of the year that pushed me to make a change. In April 2023, I had been actively working on my health for nearly a year. Despite regularly attending weight training sessions, group fitness classes, and working out solo, I found myself unexpectedly gaining 10 pounds. As I approached a milestone birthday, I realized that it was time for a reassessment of my health journey.
Staring into the mirror, I asked myself, “What am I waiting for?” I knew what I needed to do, but I hadn’t been fully committed. That moment sparked a decision: I reached out to a nutritionist to help guide me through managing my macros. Over the next six months, the changes began to click. I gradually lost the weight, gained muscle definition, and felt my mental health improve. Eighteen months later, I had surpassed my initial goal, shedding 40 pounds.
Reflecting on my physical progress, I was reminded of a milestone I reached on January 15, 2024, when I burned 477 calories during a 4.65-mile hike. By September 2024, I completed a 20-mile hike in the Cuyahoga Valley National Park, burning over 3,000 calories and covering the distance in nearly six hours. Inspired by this accomplishment, I’m considering even more challenging hikes in 2025.
While my personal experience did not include the use of GLP-1 drugs, they have become a significant topic of discussion in my field. As someone working in the self-funded health plan space, I’ve been closely following new developments in health technologies, including GLP-1 and GIP medications. Despite the increasing availability of these drugs, I chose not to go that route due to concerns about potential side effects and the steep financial burden they could place on my health plan.
GLP-1 medications, which work by regulating blood sugar and appetite, have proven effective for many individuals struggling with weight loss. However, they are not without risks. Side effects include nausea, vomiting, diarrhea, pancreatitis, kidney and gallbladder issues, and even more severe risks such as increased heart rate, vision changes, blood clots, and certain types of thyroid cancers. For many, the side effects may be mild but are still not without concern.
Another factor in my decision was the cost of these drugs. In the U.S., GLP-1 medications can cost upwards of $1,000 per month, which many health plans may only partially cover, leaving patients with high out-of-pocket costs. This poses a challenge for many, especially those who need to meet a high deductible before receiving full coverage.
As of January 2025, however, North Dakota became the first state to add GLP-1 and GIP drugs to its benchmark plan as an essential health benefit. The inclusion of these drugs in the state’s health plans is part of a broader move to cover therapies for obesity, diabetes-related conditions, and other metabolic issues under nutritional counseling.
This policy change highlights the growing recognition of the therapeutic potential of GLP-1 drugs. Although self-funded health plans are not required to mirror the benchmark plans, they may choose to adopt similar benefits. The inclusion of GLP-1s in insurance coverage could be a game-changer for many, though the long-term effects of these drugs remain uncertain.
For those who are hesitant, there are success stories to consider. A colleague’s father, who had been struggling with diabetes for over 24 years, experienced remarkable results with a GLP-1 medication. After two years on the drug, he lost 160 pounds, stopped taking blood pressure medication, and no longer required insulin. This transformation was a testament to the life-changing potential of GLP-1s when paired with a healthy lifestyle.
Similarly, a close friend of mine began using Ozempic, a GLP-1 drug, after being diagnosed with type 2 diabetes. Her journey has been a combination of medication and consistent effort to improve her diet and exercise habits. After six months, she had lost over 35 pounds, and her A1c levels dropped from 7 to 5.9, a significant improvement. While she did experience some common side effects, like constipation, she emphasizes that her success is also due to her active involvement in her health.
Despite the promising outcomes some individuals have experienced, the long-term effects of GLP-1 drugs remain an area of ongoing study. As the landscape of pharmacy benefit managers (PBMs) and insurance coverage evolves, the inclusion of these drugs in health plans will likely continue to be a topic of discussion.
Ultimately, the choice to use GLP-1 medications, like any health-related decision, is highly personal. As I have learned through my own journey, what works for one person may not work for another. For those considering GLP-1s or any weight-loss strategy, it is important to weigh all options and select the path that feels right for them.
As someone with a background in law and healthcare cost containment, I encourage individuals on their health journeys to consult with healthcare providers, consider all available treatments, and make informed decisions that align with their personal goals and needs. The path to health and wellness is unique for everyone, and no single solution fits all.
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