Weight Loss Drugs in Workers’ Compensation are becoming an increasingly important topic as employers, insurers, and healthcare providers look for ways to improve outcomes and reduce claim costs.
When I first entered the field of case management, I frequently worked on workers’ compensation cases involving low back pain. A common request was to place a treadmill in the injured worker’s home. The goal was to encourage weight loss and improve recovery.
The running joke became what the world’s most expensive clothes hanger was, and the answer is that treadmill.
The Rise of GLP-1 Medications: A New Weight Loss Frontier
There is an ever-escalating use of a medication developed for diabetes known as glucagon–like peptide–1 (GLP-1), more commonly known as Ozempic, Wegovy, Victoza, and Trulicity. The development of these medications dates back more than 100 years.
The growing demand for these drugs has created shortages. It has also increased the market for compounded alternatives.
As one who has participated in the battle of the bulge for my entire adult life, I can assure you that losing weight is a particularly difficult challenge.
Most healthcare providers support interventions that help patients lose weight. Recently, a file came across my desk asking for this medication to assist the injured individual in a weight loss program that “would most assuredly” benefit the recovery from the compensable injury sustained by the injured employee.
However, the question becomes, is this particularly extensive medication warranted to address a soft tissue myofascial strain in an obese individual?
The primary goal of workers’ compensation is to help injured employees recover and safely return to work. Treatment should support functional improvement and positive outcomes. The identified comorbidities of diabetes, obesity, and a recovery challenge. Part of the overall figure plan is to address these unrelated comorbidities and remove the identified barriers to recovery.
Unpacking the Cost and Clinical Evidence for GLP-1s
These medications now play a larger role in healthcare. Occupational health professionals should carefully review their use in workers’ compensation claims.
My review found little evidence showing long-term behavior changes. Researchers have not clearly shown that patients maintain weight loss after stopping the medication.
Thus, consideration of the proposed use of these medications must be detailed, debated, and insightful. Moreover, the cost factors need to be part of this discussion.
A recent article noted that a majority of the drug spend for a Blue Cross/Blue Shield system for the entire state was simply addressing this medication. The clinical records provided by the treating providers must address and scrutinize the need for this medication.
Obesity and Injury: A Pre-Existing Condition or a Complication?
As noted in every statute across the land, the workers’ compensation payer is to provide all care reasonably required to address the sequela of the compensable event. Is obesity a pre-existing condition or a function of the identified injury?
The same can be asked about the noted diagnosis of diabetes, a particularly common, unrelated comorbidity identified in injured employees.
Potential Benefits: How GLP-1s Might Aid Recovery
It is without a doubt that many musculoskeletal injuries, particularly those involving the knees, hips, and lower back, are compromised by degenerative joint disease or soft tissue damage that was exacerbated by excessive body weight.
Weight loss from GLP-1 medications may reduce stress on joints. As a result, some injured workers may experience less pain.
This improvement may support better orthopedic outcomes and recovery.
Long-term injuries can contribute to depression, anxiety, and unhealthy eating habits. GLP-1 medications may help some patients address these challenges.
The literature reflects that the utilization of this specific medication protocol is still being studied with respect to the psychological factors and the attached workers’ compensation injury.
The Missing Link: Why More Data is Needed Before Widespread Adoption
Clearly, there are cogent arguments to be offered for the utilization of this protocol.
However, the underlying fact remains that obesity was present before the injury, and there is no specific objective data presented that the current body habitus is in any way compromised by the compensable event.
Consequently, before endorsing the utilization of this medication protocol, there needs to be specific objective clinical data that definitively establishes the utility or efficacy of this approach when treating a compensable injury.
In any event, a detailed utilization review process needs to be completed prior to incorporating this protocol. While some authors feel that with increasing studies and data, these drugs may become an important tool in managing the complex and unrelated comorbidities attached to these claims. However, currently, that data is not present.
