With 1.5m Britons now using injections to lose weight and a further NHS rollout on the cards, we must consider their potential impact on claims, says Dan Simpson, Chief Innovation Officer at Shepherds Friendly
Once reserved for diabetes patients, GLP-1 drugs like Ozempic, Wegovy and Mounjaro are now in such high demand that a University College London study suggested nearly one in 10 adults in in the UK had either used them or was interested in doing so. On the NHS, prescriptions remain tightly rationed, but privately demand has soared – driving consumers to both licensed providers and unregulated online sources.
With uncertainty over provenance, it’s hard to know exactly how many people in the UK are taking such drugs, but estimates from clinical analytics company IQVIA suggest it’s about 1.5 million. One thing that is certain is that this is set to rise, with the National Institute for Health and Care Excellence last month launching a consultation on plans to significantly ramp up their use, citing concerns of under-prescribing at present.
Each of these medications has implications for health, for consumers, and for protection insurers. The usage trends reflect not just shifts in health behaviour and healthcare costs; they have real implications for underwriting, disclosure, and ultimately the way in which risk is assessed.
From BMI snapshots to weight trends
BMI has long been fundamental to protection underwriting. A high BMI is linked with greater incidence of diabetes, cardiovascular disease, sleep apnoea, certain cancers, respiratory issues, musculoskeletal problems and a range of other conditions that already drive a significant volume of claims.
At Shepherds Friendly, for example, musculoskeletal conditions accounted for 55.8% of new income protection claims last year and more than half of the total payout value (54.6%). Chest/lung/nose/throat conditions made up 6.9% of new claims, with heart conditions responsible for the same percentage, and cancer accounting for 4% of claims.
On the face of it, any intervention that reduces obesity levels should be positive for the protection market, because lower BMI could mean fewer musculoskeletal claims, reduced sleep apnoea, better quality of life, lessened risk of cancer, and a lower likelihood of major cardiac events. Yet the picture is complicated.
Side-effects such as nausea, vomiting and gastrointestinal problems are common, and in rarer cases more serious issues such as pancreatitis or gallbladder disorders have been reported. These could translate into short-term absences from work and, in some cases, repeat claims.
Stopping treatment – particularly among private patients who fund the medication themselves – also often results in rapid weight regain, meaning improvements are not always sustained. For insurers, the challenge is how to assess such a risk fairly: should pricing be based on short-term changes, or only on health improvements that can be sustained over time? And if so, how would that be determined?
We are already looking to adapt our underwriting approach, by updating our questions to take account of weight trends over the past 12 months, rather than relying on a single snapshot figure. Rapid weight loss – whether through medication, surgery or lifestyle change – will in future need to be assessed more carefully, with greater emphasis on the average weight maintained across time. This reflects the reality that while a reduction in weight is positive, it does not erase the legacy risks of years spent at a higher BMI.
On the other hand, a 25-year-old who loses a significant amount of weight may have a very different long-term outlook to a 45-year-old. Over time, it is likely that underwriting will need to move beyond BMI altogether to build a fuller picture of overall risk.
Disclosure and blind spots
Another concern is disclosure. Private treatments may go unrecorded in a patient’s NHS history and, if counterfeit, could even be dangerous.
Insurance is built on good faith. If applicants fail to mention weight-loss drugs, either because they assume a private prescription “doesn’t count” or because they do not want it to affect their premium, that raises the risk of disputes at claim stage.
For providers, the response must be clearer application questions. By asking specifically about significant weight loss and recent use of weight-loss medication, insurers can reduce the risk of non-disclosure. Advisers have a role here too, helping clients understand that transparency is always in their best interests.
There is also the practical matter of how different scenarios are treated. Someone who discloses treatment prescribed by their GP and is maintaining weight loss may be accepted on standard terms. Someone who refuses to disclose the source, or admits to buying drugs informally, could face a decline. Advisers who understand these distinctions will be better able to set expectations with their clients.
The long-term impact of these drugs on protection claims is still unknown. Wider NHS access or lower costs could encourage greater adherence, leading to more sustainable improvements. Equally, new clinical evidence could reveal additional benefits – or new risks.
It’s still early days, so the outlook is one of cautious optimism. If clients stay on treatment, the likelihood of reduced claims (and better health outcomes) is strong. But for now, insurers may be unwilling to reward temporary changes.
The bigger lesson may be broader still. Weight-loss drugs are simply the latest example of medical innovation challenging traditional insurance models. The industry has already had to revisit mental health underwriting as reporting trends have changed, and similar questions are now being asked about wearable technology and genetic testing. The pace of change in healthcare is unlikely to slow.
For advisers, this means two things. First, encouraging clients to disclose fully and set realistic expectations around premiums in light of emerging treatments. And second, recognising that protection products are dynamic so underwriting approaches will also have to evolve.
Weight-loss medication could well prove to be one of the most significant public health developments of the decade. For insurers, the opportunity lies in healthier lives, fewer long-term claims and more sustainable outcomes for members. The challenge is to match that with fair underwriting, full disclosure and confidence that improvements are genuine and lasting.
At Shepherds Friendly, we will continue to monitor claims as our knowledge of this area develops. Nobody in the industry can claim to have all the answers just yet, but we must be alert to these developments and ready to adapt.
Dan Simpson is Chief Innovation Officer at Shepherds Friendly
