Title: Life Insurance Underwriting and Weight Loss Medications

Introduction:

I am Jennifer Rancourt, a seasoned Senior Underwriting Consultant, who joined Principal

Financial in the summer of 2023, bringing extensive experience from direct carriers like

Symetra and Lincoln Financial. My career spans back to 1995, I am passionate about the

dynamic nature of life underwriting. I relish the unique challenges each case presents and

am dedicated to continuous education, holding professional designations such as FALU,

FLMI, ARA, and ACS. In my pursuit of lifelong learning, I have recently started pursuing my

CLU designation, setting an example for my sons that attend UCONN. My academic

background includes a bachelor’s in business with a major in Actuarial Studies from the

University of Hartford. My vibrant personality found its perfect match in the world of life

underwriting.

I’m thrilled to be in the running for The Rick Weaver Award, a nod to the memory of

someone who shared my passion for underwriting. My time working alongside Rick at

Lincoln Financial was truly special. He was a wealth of knowledge, especially when it came

to financial underwriting, and he never hesitated to share that knowledge or help a curious

underwriter like me. I feel lucky to have known him.

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Weight Loss Medications:

In the ever-evolving landscape of healthcare, “Skinny Shotz,” also known as Ozempic or

Semaglutide, has gained popularity as a once-a-week injection for weight loss. Notably,

celebrities like Kim Kardashian and Elon Musk have openly acknowledged using this

medication to achieve their desired physique. However, it’s not limited to the rich and

famous; many individuals, including mothers dealing with postpartum or menopausal

weight gain during the Covid lockdown, have turned to these medications.

The Obesity Epidemic:

Obesity is a pressing issue in the United States, affecting over 40% of adults, according to

the National Health and Nutrition Examination Survey (1999-2018). The Centers for

Disease Control and Prevention (CDC) link obesity to serious health risks like diabetes,

heart disease, and stroke. These conditions are leading causes of premature death. Weight

loss is often the initial recommendation for managing blood sugar, hypertension, and

cholesterol levels. While traditional methods like diet and exercise remain effective, more

extreme options such as bariatric surgery and FDA-approved weight loss medications like

Wegovy and the soon-to-be-approved Mounjaro are gaining traction.

Evolution of Weight Loss Medications:

Weight loss medications aren’t a novel concept, but they have become more accessible and

effective over time. Phentermine, a stimulant and appetite suppressant, received FDA

approval for short-term weight loss use in 1959. In 2012, topiramate gained approval for

long-term appetite suppression. Combining these two drugs was also approved in 2012,

although they can lead to side effects like palpitations and insomnia.

Contrave, a combination of bupropion and naltrexone, targets the brain’s appetite

regulatory center and the mesolimbic reward system. However, its effectiveness tends to

wane after a year of use.

Orlistat takes a different approach, blocking the absorption of about 25% of dietary fat.

While effective, it requires a low-fat diet due to side effects such as bowel urgency and

vitamin deficiencies.

In 2014, liraglutide (Saxenda) entered the market as an FDA-approved weight loss

medication, originally designed for diabetes management. It has minimal side effects,

including nausea and constipation. Semaglutide (Wegovy), a weekly injection GLP-1

agonist, was approved in 2021, showing remarkable weight loss results, akin to bariatric

surgery.

Scheduled for approval in 2024, Mounjaro offers a weekly injection with a substantial 20%

total body weight loss boost, thanks to its combination of GLP-1 and GIP receptor agonists.

Understanding GLP-1:

GLP-1, or glucagon-like peptide-1 receptor, is a natural digestive hormone in our bodies.

Semaglutide mimics this hormone, promoting insulin production and reducing glucagon

production in the pancreas. It also delays gastric emptying, leading to increased satiety, and

suppresses hunger cravings primarily in the hypothalamus of the brain. Clinical trials have

demonstrated significant weight loss, although side effects like nausea, vomiting, diarrhea,

abdominal pain, and constipation may occur, with rare cases of severe gastroparesis.

Long-Term Considerations:

Given the novelty of these medications, their long-term side effects remain uncertain.

However, it’s assumed that patients may require lifelong use of GLP-1 weight loss

medications, similar to treatments for hypertension or diabetes. Concerns have arisen

about potential muscle loss in elderly patients, which could impact immunity, bone density,

and overall longevity. On the positive side, these medications offer better control over

blood pressure, A1c levels, and lipids, potentially resolving related conditions such as

hypertension, diabetes, and sleep apnea, all of which contribute to cardiovascular disease.

Underwriting Weight Loss Medications:

Underwriting weight loss medications should align with the principles applied to

intentional weight loss through diet and exercise. Key considerations include:

• Type of Medication: Determine which weight loss medication the applicant is

using, whether it’s Wegovy, Mounjaro, or a compound such as semaglutide with

B12.

• Pretreatment Weight: This helps calibrate the weight loss, as typically half of the

lost weight is added back within a year.

• Treatment Duration: Understand how long the treatment has been ongoing,

whether it’s recent or part of a long-term plan.

• Dosage and Frequency: Assess whether the applicant is still titrating the dosage or

has transitioned to a lower maintenance dose or a schedule with more days

between injections.

• Prescribing Source: Consider whether the medication is prescribed by a primary

physician or a weight loss specialist, with additional scrutiny if obtained from a med

spa due to concerns about medical supervision.

• Lifestyle Changes: Inquire about any accompanying lifestyle changes in terms of

diet and exercise.

• Current Labs: Review essential lab results, including thyroid function, A1c levels,

complete blood count, and a comprehensive metabolic profile.

As with any underwriting guidelines, these considerations serve as a framework for

making informed decisions about applicants using weight loss medications. It’s essential to

tailor assessments to individual cases while keeping in mind that an occasional indulgence,

like a cupcake for breakfast, is part of the balance of life.