Beyond BMI: Our New Approach to Weight Management Benefits
How employers can help employees manage this chronic condition
Beyond BMI: Our New Approach to Weight Management Benefits
How employers can help employees manage this chronic condition
Obesity is a complex, chronic disease that affects nearly one in three Canadians. The economic impact is substantial, costing $27.6 billion annually, with productivity losses three times higher than direct healthcare costs.*
In our recent Insights webinar, we explored the latest treatments, as well as behavioural and psychological support options available to plan members. We shared strategies for plan administration and showed how creating a supportive workplace, employers can improve employee health, productivity, and retention while reducing costs.
Key takeaways
- Obesity is a complex chronic disease, not a lifestyle choice.
- Effective treatments exist and significantly reduce related health conditions.
- Plan design matters: Prior authorization and outcome-based reassessment support appropriate use and sustainability.
- We’ve evolved beyond BMI to include a combination of health factors and current medical guidelines.
- Medication is just one part of treatment. Long-lasting results come from a combination of medical, behavioural, and psychological care.
Our new approach
Despite evolving medical definitions of obesity, healthcare practices sometimes still rely on outdated measures such as Body Mass Index (BMI) alone. BMI is a simple calculation based on your weight and height. It’s commonly used to estimate whether a person is underweight, a healthy weight, overweight, or obese.
As part of this webinar, we introduced our new approach to addressing obesity — one that’s based on strong medical evidence and focuses on care that works, while also keeping health plans affordable.
As well, we’ve moved beyond using BMI alone as a diagnostic tool for treatment.
Understanding obesity as a chronic condition
Obesity is recognized by both the Canadian Medical Association and the World Health Organization as a chronic, progressive, and relapsing disease.
It is no longer seen as a condition caused by a lack of willpower. Instead, we now understand that it can happen for several reasons, including:
- Genetics (what you inherit from your family)
- Biology (how your body works)
- Environmental (where you live and what’s around you)
- Behaviours (eating, sleeping, and activity habits)
- Social influences (stress, culture, and support from others)
Understanding obesity as a chronic condition
Obesity is recognized by both the Canadian Medical Association and the World Health Organization as a chronic, progressive, and relapsing disease.
It is no longer seen as a condition caused by a lack of willpower. Instead, we now understand that it can happen for several reasons, including:
- Genetics (what you inherit from your family)
- Biology (how your body works)
- Environmental (where you live and what’s around you)
- Behaviours (eating, sleeping, and activity habits)
- Social influences (stress, culture, and support from others)
Health risks linked to obesity
Obesity significantly increases the risk of more than 200 chronic conditions, including:
- Cardiovascular disease
- Type 2 diabetes
- Respiratory disease
- Cancer
- Certain mental health conditions
The costs of untreated obesity
According to Obesity Canada’s Cost of Inaction report, untreated obesity in Canada results in a $27.6 billion annual burden, including:
- Over 19 million additional physician visits
- 10,000 seniors in long-term care
- $21.7 billion in indirect costs, such as lost productivity, missed work, disability, and early death
More than financial, the emotional burden is heavy: over half of Canadians living with obesity report mental health challenges, social isolation, and a lower quality of life due to weight stigma.
The impact extends beyond personal wellbeing and also influences employment opportunities, wages, and career advancement.
An estimated 90% of Canadians with Type 2 diabetes also live with obesity. The good news is that even modest weight loss can significantly reduce this risk, while a sustained 15% loss has been associated with diabetes remission.
These findings underscore the importance of comprehensive weight management strategies for both the prevention and treatment of chronic diseases.
Learn more:
The rising demand for weight management drugs
Medavie Blue Cross’s 2024 claims data reflect a rising demand for weight management:
- Weight management drug claims surged 150% in 2024 vs. 2023, though overall incidence remains low
- Wegovy, available since May 2024, now accounts for 62% of weight management drug spending — the leading product in this category.
- Members claiming weight management medications are often managing other chronic conditions such as diabetes, inflammatory diseases, respiratory issues, and mental health concerns.
- 79% of claimants are women.
This rapid growth reflects strong clinical evidence, high public interest, and media attention. It also signals the need for responsible, sustainable plan design.
Learn More: What’s Trending in Health and Drugs Benefits?
The rising demand for weight management drugs
Medavie Blue Cross’s 2024 claims data reflect a rising demand for weight management:
- Weight management drug claims surged 150% in 2024 vs. 2023, though overall incidence remains low
- Wegovy, available since May 2024, now accounts for 62% of weight management drug spending — the leading product in this category.
- Members claiming weight management medications are often managing other chronic conditions such as diabetes, inflammatory diseases, respiratory issues, and mental health concerns.
- 79% of claimants are women.
This rapid growth reflects strong clinical evidence, high public interest, and media attention. It also signals the need for responsible, sustainable plan design.
Learn More: What’s Trending in Health and Drugs Benefits?
How Medavie Blue Cross delivers smarter solutions
We believe pharmacy benefits should reflect real health needs and emerging drug trends, with a careful balance of:
- Clinical integrity
- Member access
- Cost sustainability
Thanks to our proprietary technology platform, we can manage complexity, adapt to evolving trends, and support positive health outcomes, especially in high-impact areas like obesity.
Our in-house Medication Advisory Panel, comprised of physicians, pharmacists, and health economists, reviews every drug on our formulary for clinical value and cost-effectiveness.
Smart Benefit Design
Weight management medications are part of a distinct benefit module, and plan sponsors can choose how these benefits are structured:
- Some list them as regular benefits
- Others use prior authorization
- Dollar or time limits may also apply
Medavie Blue Cross recommends the use of prior authorizations without imposing maximum limits.
Maximums (especially with lifetime or very low maximums) create significant barriers for patients in accessing medications. These treatments are intended for long-term use, as obesity is a chronic condition. Discontinuing therapy can lead to serious, well-documented adverse health outcomes. To truly support the health and well-being of individuals living with obesity, sustainable coverage is essential.
Until recently, prior authorization relied solely on BMI. In April 2025, we expanded our criteria to reflect current Canadian guidelines, including:
- A BMI of 27–34.9, with a high waist circumference (adjusted for ethnicity), or BMI of 35+
- Documented obesity-related complications (e.g., sleep apnea, joint pain, prediabetes, liver or cardiac conditions)
- Evidence of dietary changes, increased physical activity, and behavioural or psychological interventions
We also require ongoing reassessments to confirm the medication is working and delivering meaningful health outcomes.
Understanding Treatment Options
While medications like Semaglutide and Tirzepatide are effective, they work best when used correctly, consistently and with extra support. Improper use can lead to early discontinuation, minimal weight loss, and missed improvement in comorbidities.
There’s no one-size-fits-all solution. Research supports three pillars of obesity treatment:
Psychological Support
- Cognitive Behavioural Therapy (CBT)
- Stress and sleep management
- Mindfulness-based supports
Pharmacological Therapy
- Liraglutide, Semaglutide (Wegovy), Tirzepatide
- Naltrexone-Bupropion, Orlistat
Bariatric Surgery
- Gastric bypass
- Sleeve gastrectomy
- Duodenal switch
These treatments are meant to be considered as additions to Medical Nutrition Therapy (MNT) and physical activity, which by themselves are not treatment but constitute foundational supports.
Whole health support
Tools and services from Medavie Blue Cross
Medavie Blue Cross offers a full range of services to help members stay on track with their health goals.
- Connected Care: A robust digital health and wellness platform including:
- 360 Total Care: Personalized health coaching, smart digital tools (e.g., connected scales, blood pressure cuffs), and condition-specific education for obesity, diabetes, and hypertension.
- 360 Harmony: One-on-one nutrition counselling with a registered dietitian.
- Personal Wellness Account (PWA): A flexible, employer-sponsored account that supports nutritional counselling, fitness, wellness programs, and more.
- Blue Advantage®: A discount program for health and wellness products and services across Canada.
- inConfidence® EFAP: Offers lifestyle coaching, nutrition counselling, therapy, and internet-based CBT.
Checklist: Weight management solutions
Employers have an opportunity to improve health, productivity, and retention by designing benefits that reflect the latest science. We recommend:
- Weight management benefit with prior authorization (no maximums)
- Dietitian coverage
- Health coaching and chronic disease management
- Expanded mental health benefits
- Personal Wellness Account
By building inclusive workplaces and offering thoughtful, evidence-based benefits, employers can improve employee health and productivity, reduce costs, and become part of the solution in addressing one of Canada’s most pressing public health challenges.
*Source: Obesity Canada
Support Starts Here
Connect with your Medavie Blue Cross representative today and learn more about our weight management solutions.
Posted by Medavie Blue Cross on July 29, 2025
Medavie Blue Cross is a premier all-in-one carrier that provides health, dental, travel, life and disability benefits and administers federal and provincial government-sponsored health programs. Together with Medavie Health Services, we are part of Medavie, a health solutions partner committed to improving the wellbeing of Canadians. We are in the...