Metabolism Matters: Building a Blueprint for Improved Outcomes

Left untreated, poor metabolic health can lead to significant health care costs for both members and payors – and a vast majority of U.S. adults have risk factors.¹

Metabolic health is defined as having optimal levels of:

• Waist circumference
• Glucose
• Blood pressure
• Triglycerides
• High-density lipoprotein (HDL) cholesterol

These factors have a direct correlation to a person’s risk for heart disease, diabetes, and stroke. Because metabolic health is closely linked to insulin resistance, there is frequently a progression to prediabetes and then to type 2 diabetes. Prediabetes usually occurs in people who already have some insulin resistance.

Insulin resistance occurs when cells in the muscles, fat, and liver don’t respond well to insulin and can’t easily take up glucose from the blood. As a result, the pancreas makes more insulin to help glucose enter cells.³Without enough insulin, extra glucose stays in the bloodstream rather than entering the cells.

Recently, “metabolic health” has entered the lexicon as an umbrella term for the intersection of diabetes and obesity. Metabolic health is a growing health concern, but the cause and drivers are not yet completely understood.⁴

Exploring the link between diabetes and obesity

Now more than ever, we see the overlap in both risk and prevalence of type 2 diabetes and obesity. Type 2 diabetes is a complex, chronic health condition with multiple contributing factors. More than 37 million people in the United States have diabetes and another 96 million U.S. adults have prediabetes. People with diabetes are at higher risk for heart disease, stroke, and other serious complications that can lead to poor health outcomes and higher health care spend.

Diabetes is the most expensive chronic condition. One out of every four dollars in U.S. health care spending goes to diabetes care.⁵As more people develop diabetes, rising costs are becoming a major concern for payors and members alike.

Obesity is a key risk factor for type 2 diabetes and among U.S. adults diagnosed with diabetes, almost 90 percent were overweight or obese.⁶There is a link between ultra-processed food and body mass index, and research finds that the high consumption of this type of food in the United States has continually increased during the past two decades.⁷⁸

At the same time, the majority of Americans do not meet the guidelines for aerobic and muscle strength activity targets.⁹

The link between diabetes, obesity, and metabolic health is complex and has multiple potential factors such as inflammation, insulin resistance, and impaired fat storage in cells. Although it is challenging to pinpoint the exact mechanism by which obesity may lead to type 2 diabetes, studies have shown that weight loss reduces the risk of developing diabetes.

In response to the rising rates of obesity and diabetes, and the long-term health risks for both conditions, the medical community has updated clinical practice guidelines to recognize obesity as a chronic disease and emphasize the importance of weight loss.

In 2013, the American Medical Association officially identified obesity as a chronic condition.¹¹In January 2023, the American Academy of Pediatrics issued its first comprehensive guideline for obesity in children. Obesity is a mounting health concern among children and adolescents, with almost 20 percent of children considered obese, according to the U.S. Centers for Disease Control and Prevention. Nutrition plays a central role in overall health and is a critical part of health and development.¹²

The American Diabetes Association 2023 Standards of Care in Diabetes include several updates. Specific to obesity, the guidelines emphasize supporting higher weight loss (up to 15 percent; previous guidelines suggested up to 5 percent weight loss).¹⁴The guidelines also recommend an individualized approach starting from diagnosis, offering more flexibility to use drug classes like GLP-1 agonists as initial therapy.

Social determinants of metabolic health

Over their lifetime, U.S. adults overall have a 40 percent chance of developing type 2 diabetes. People of color are at disproportionate risk for diabetes and obesity.

For example, Black adults are nearly twice as likely as white adults to develop type 2 diabetes.¹⁵For Hispanic or Latino adults, the chance is more than 50 percent, and they’re likely to develop the condition at a younger age.¹⁶

Black women in particular have the highest rates of obesity compared to other groups in the United States. About 4 out of 5 Black women are overweight or obese.¹⁷

Multiple factors contribute to these inequities across race, ethnicity, and socioeconomic status. To best meet the needs of a diverse member population, payors should ensure that their offerings address social determinants of health, leveraging local resources if necessary, so that each member has the tools they need to succeed with weight loss.

Addressing metabolic health holistically

Many weight loss drugs currently on the market were originally introduced to treat type 2 diabetes; once weight loss became an evident side effect, manufacturers sought approval for new indications and developed new versions of their diabetes drugs. Ongoing trials will further assess the safety of long-term use. Like all therapeutics, there are side effects and risks that need to be weighed carefully with the expected benefits of the drug. Still, sustained weight loss efforts require more than just the use of medication.

The evolving metabolic health landscape requires a holistic approach to help contain costs while helping to preserve clinical quality. The potential cost of poor metabolic health for payors is too great to ignore.