Navigating the Obesity Epidemic Through Enhanced Risk Management Solutions
Obesity: addressing an underappreciated risk
(as of 2019)
COVID-19 has highlighted the profound impact of obesity on many aspects of health
The significant impact of obesity on COVID-19 mortality provides stark evidence of the myriad and underappreciated ways that obesity undermines health and heightens mortality.
Analyses have found that those with a body mass index (BMI) of 35 or more have fared significantly worse in the pandemic, with one study concluding that “obesity plays a profound role in risk for death from COVID-19, particularly in male patients and younger populations.”3 The increasing frequency of epidemics due to globalization and climate change suggests that the risk to those who are obese is similarly increasing.
Obesity is no longer an acute disease, but a chronic one
BMI at an individual level also continues to creep upward from early childhood through late middle age. A Canadian study measuring the average 5-year change in BMI for individuals in different age cohorts found that BMI increased for every age cohort, except for those over age 65. (see Figure 2.)
Both academic papers and our own research show an impact of between a quarter and half percent of worsening mortality each year because of these trends. This makes it more critical than ever to leverage the appropriate tools for identifying ‘healthy obese’ and accurately pricing those with heightened risk.
Munich Re’s new Metabolic Risk Calculator helps insurers gain a more nuanced view of obesity risk
Current underwriting that assigns the same level of risk to all individuals with a given BMI ignores the fact that metabolic health can vary considerably among those with the same BMI. By focusing on BMI in isolation, the industry is underpricing certain risks that will hurt profitability in the long term and missing the opportunity to find bright spots where a more favorable approach is warranted. The key is moving beyond imprecise measures like BMI in isolation to holistically consider multiple associated factors to more accurately assess metabolic health.
Munich Re has developed a multivariate, evidence-based Metabolic Risk Calculator that allows insurers to better assess metabolic risk by:
Relying on a multivariate analysis of multiple metabolic risk factors
Based on an analysis of multiple risk factors and actual outcomes for 1.5 million insurance applicants in the U.S., our metabolic risk calculator assesses mortality risk based not only on multiple factors such as build, blood pressure, cholesterol, and more, but also on the associations among these various factors. This will give users a much more nuanced picture of an applicant’s actual mortality risk than can be determined by scoring each risk factor independently.
Better assessing the impact of age on metabolic risk
Adolescents with high BMIs are a worse risk than older people with the same BMIs, all other factors being equal, due to the increased length of time they have to develop comorbidities as a result. The metabolic risk calculator automatically assesses BMI in the context of age through its multivariate approach, appropriately weighting mortality risk for obese individuals in different age groups.
Simplifying the underwriting experience
Replacing separate individual calculators for various risk factors with one comprehensive calculator will also save insurers significant time and effort in assessing metabolic risk.
Addressing the fact that not all obesity poses the same risk
It is critical to identify the more metabolically healthy, even among obese applicants. Rather than downgrading risk for everyone with a BMI over 30, the calculator enables a more accurate assessment of risk on an individual basis, allowing insurers to be more precise and competitive.
To do this, our metabolic risk calculator:
Includes waist-to-height ratio. Although easy to calculate, BMI cannot distinguish between lean and fat mass or shed light on how fat is distributed in the body. Instead, body composition — a measure of the fat, muscle, water, and bone in the body — and how fat is distributed in the body are more closely correlated to adverse health outcomes than BMI. Our metabolic risk calculator incorporates a waist-to-height ratio to provide this more accurate view of body composition and better assess risk.
Adds exercise levels and Brain Natriuretic Peptide (NT-proBNP) as additional measures to estimate true risk: Cardiac function screening tests, such as an exercise tolerance test, echocardiogram, NT-proBNP, and a coronary calcium score, can uncover the presence of early changes that may impact an individual’s metabolic risk. Our calculator allows for the assessment of those metabolic risks.
- Focusing on BMI in isolation leads to underpriced risks that hurt profitability in the long term
- Waist-to-height ratio provides a more accurate view of body composition
- Not all obesity poses the same risk
The vast expansion of accelerated underwriting programs demands a new perspective on obesity risk
In today’s hyper-competitive landscape, accelerated underwriting approaches offer speed and simplicity for a better customer experience and lower acquisition costs. But driving high straight-through processing rates while also mitigating potentially greater mortality risk is critical to maintaining profitability.
Successfully balancing risk and pricing to maintain competitiveness and profitability requires robust risk monitoring, management, and mitigation tools. The transition toward fluidless programs has increased the urgency around discovering new ways to manage obesity risk. We are developing sophisticated tools and cutting-edge technology to enhance risk management.
Munich Re’s Digital Assessment Platform (DAP), built on advanced machine learning, predictive analytics, and our underwriting expertise, helps insurers gain real-time insights to improve risk selection and identify areas of opportunity by:
Identify patterns of BMI misrepresentation proactively
BMI misrepresentation has emerged as one of the main drivers of misclassification — second only to smoking non-disclosure — in accelerated underwriting programs. With research confirming BMI misrepresentation rates of 20% or higher in fully underwritten programs, these rates are expected to increase in accelerated programs, imposing a material impact on mortality risk.5
But not all applicants have the same likelihood of misrepresenting their BMI and also vary in the magnitude of their underreporting.
Anticipating the probability and magnitude of this misrepresentation is key for identifying high-risk applicants and mitigating the extra mortality impact.
Munich Re’s BMI misrepresentation predictive model helps to identify these patterns of BMI misrepresentation proactively. Using data from pre-existing, fully underwritten cases, the model is trained to identify discrepancies between applicants’ reported and measured BMI. This enables it to flag those applicants likely to significantly understate their BMI to be handled appropriately to address the misrepresentation. The model also helps carriers identify patterns of misrepresentation in the distribution.
Effectively managing and mitigating metabolic risk
Despite the growing risks posed by increasing obesity in North America, new tools, predictive analytics, and disruptive technology solutions make it possible to develop fairer and more accurate pricing while potentially expanding the insured population. The key is moving beyond imprecise measures like BMI in isolation and holistically considering multiple associated factors to assess metabolic health more accurately.
As your risk management partner, Munich Re is committed to helping you develop the best understanding of metabolic risk and better assess, manage and mitigate it in your business. We also continue to study new third-party solutions with the potential to revolutionize underwriting programs. Partner with us to leverage our powerful tools and innovative solutions such as the metabolic risk calculator, DAP platform, and BMI misrepresentation model and help advance your business in this evolving insurance landscape.
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About Munich Re Life
As a leader in the life reinsurance market, Munich Re Life’s expertise expands from market-leading offerings that include individual life and living benefits reinsurance, group reinsurance and financial reinsurance, to predictive analytics, digital partnerships, and standard-setting underwriting and medical capabilities.
We believe that the digital economy offers an unprecedented opportunity for the industry to rapidly advance risk assessment and close the widening global underinsured gap.
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