Insurance Curator CHICAGO — Actuaries and life insurance underwriters have begun the complex process of recalibrating long-term mortality tables to account for the widespread adoption of GLP-1 receptor agonists, as clinical data reveals these weight-loss medications significantly reduce the risk of cardiovascular death and chronic disease.
The shift comes as global reinsurers and professional bodies, including the Society of Actuaries (SOA), analyze how drugs like semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro, Zepbound) could alter the life expectancy of policyholders over the next two decades. For an industry that relies on the "inverted pyramid" of risk assessment—placing the most certain mortality data at the foundation—the rapid emergence of these drugs represents a potential "mortality improvement" event not seen since the introduction of statins or the decline of smoking.
"We are currently in a period of intense observation," said Jean-Marc Fix, a fellow of the Society of Actuaries and a veteran life insurance consultant. "The clinical trial data is compelling, showing not just weight loss, but a fundamental reduction in major adverse cardiovascular events. The challenge for actuaries is determining how much of that clinical success translates to the general population over 20 or 30 years."
The Clinical Catalyst
The primary driver for this actuarial shift is the landmark SELECT trial, published in the New England Journal of Medicine. The study found that Wegovy reduced the risk of heart attacks, strokes, and cardiovascular deaths by 20% in overweight or obese adults without diabetes.
More recently, the FLOW trial demonstrated that semaglutide reduced the risk of kidney disease progression and death from kidney-related causes by 24%. For life insurers, these comorbidities—heart disease, stroke, and renal failure—are the primary drivers of early mortality claims.
According to a recent report by Swiss Re, one of the world’s largest reinsurers, the widespread use of GLP-1s could lead to a measurable shift in population-level mortality.
"If adherence remains high and access expands, we could see a notable decline in obesity-related mortality," the report stated. "However, the impact on insurance pricing will depend on the durability of the treatment and whether the mortality benefits persist if a patient stops the medication."
Recalibrating the Tables
Actuarial mortality tables are the mathematical foundations used to price life insurance policies. They project how many people in a specific cohort are expected to die each year. Traditionally, these tables have been adjusted for "mortality improvement"—the trend of humans living longer due to medical advancements.
However, the rise of the obesity epidemic in the United States over the last 30 years had begun to stall those improvements. Actuaries are now debating whether GLP-1s will act as a "course corrector."
"We are looking at how to incorporate 'GLP-1 efficacy factors' into our long-term projections," said David Blake, an insurance industry analyst specializing in longevity risk. "If you have a 45-year-old applicant with a BMI of 35 who is successfully using a GLP-1, their risk profile is fundamentally different today than it was five years ago. The question is: do we price that in now, or wait for five more years of real-world evidence?"
Some boutique life insurers and "insurtech" firms have already begun asking applicants about GLP-1 usage during the underwriting process. While no major carrier has officially lowered premiums across the board for GLP-1 users, industry insiders suggest that "preferred" status—the highest tier of insurability—may become more accessible to individuals who have successfully managed their weight through these medications.
The Adherence and Cost Hurdles
Despite the optimism, the actuarial community remains cautious due to three primary variables: adherence, cost, and long-term side effects.
Data from pharmacy benefit managers suggests that a significant percentage of patients stop taking GLP-1 medications within the first year, often due to gastrointestinal side effects or the high out-of-pocket costs, which can exceed $1,000 per month without insurance coverage.
"An actuary cannot assume a permanent reduction in risk if the patient stops the drug and the weight returns," Fix said. "Weight cycling, or 'yo-yo dieting,' has its own set of cardiovascular risks. Until we see long-term adherence data, the mortality tables will likely remain conservative."
Furthermore, there is the issue of socioeconomic disparity. Because these drugs are expensive and not always covered by insurance for weight loss, the mortality benefits may be concentrated among wealthier policyholders. This creates a "basis risk" for insurers, where the mortality improvements of their specific client base might outpace the general population.
Future Implications for the Industry
The integration of GLP-1 data into mortality modeling also has implications for the pension and annuity markets. If life insurance companies benefit from people living longer (paying premiums for more years), annuity providers face the opposite challenge: they must pay out benefits for a longer duration.
A 2024 analysis by Jefferies Financial Group suggested that if GLP-1s lead to a 1-to-2-year increase in average life expectancy for the obese population, the total liabilities for global pension funds could increase by billions of dollars.
"This is a double-edged sword for the insurance industry," Blake noted. "It's a win for life insurance margins, but a potential headwind for pension risk transfer and annuity providers."
For now, the American Academy of Actuaries and the Society of Actuaries are continuing to host working groups to monitor the "GLP-1 effect." Most experts expect a gradual shift in mortality tables over the next three to five years, rather than an overnight overhaul.
"The data is moving faster than the industry," said Fix. "We are watching the largest natural experiment in metabolic health in history, and the results will eventually be written in the mortality tables that govern the financial security of millions."
About the Society of Actuaries:
The SOA is a global professional organization for actuaries, providing research and education to manage financial risk.
About the SELECT Trial:
The Semaglutide Effects on Cardiovascular Outcomes in People with Overweight or Obesity (SELECT) trial was a randomized, double-blind, placebo-controlled study involving 17,604 participants.