A microsimulation projected 10-year outcomes for 107.6 million US adults with obesity across four insurance groups. Three access scenarios were compared: current limits, lifestyle management or older medications, and incretin-based therapies. Against incretin treatment, inaction allowed 5.3 million deaths, 5.0 million diabetes cases and 5.5 million heart failure cases. It also allowed 2.8 million strokes, 1.3 million myocardial infarctions and 1.5 million obesity-related cancers. Foregone benefits totalled $10.5-13.3 trillion: $1.8 trillion medical, $3.0 trillion productivity, $5.6-8.5 trillion quality of life. Scenarios are hypothetical, assume trial-level weight loss is sustained, and real-world discontinuation may be higher.
Why it is interesting: Reframes obesity coverage as the cost of complications already accruing rather than the cost of drugs. Medical savings are only 16-19% of the modelled value; the rest is productivity and quality of life.
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