In July, 2025, Dan Reynolds, the editor in chief of Risk & Insurance, caught up with Neil Sprackling, U.S. Life & Health CEO for Swiss Re. The topic was the dire state of metabolic health in the U.S. and how life and health insurers can work to prevent poor health outcomes. What follows is a transcript of that discussion, edited for length and clarity.

Risk & Insurance: Nice to meet you Neil. Why is metabolic health such an important topic right now?

Neil Sprackling: I’ve been around the industry for about forty years, and I’ve seen many factors that have improved mortality, which is good for everyone, good for our business and good for people in general. Smoking cessation has had a massive impact on mortality over this period. We’ve also seen improvements in longevity due to medical advances and better diagnostic techniques.

But metabolic health is like a gray cloud sitting right in front of us. It’s not new, it’s not getting better, and if we don’t address it, the consequences will extend far beyond just the life insurance industry.

What we should really be discussing is metabolic ill health. The statistics are alarming: 53 percent of US adults are either pre-type two diabetic or already type two diabetic. Furthermore, 70 percent of US adults are medically designated as overweight or obese.

I remember talking about obesity in the industry 20 years ago, warning that we’d face a significant problem if we didn’t take action. Here we are two decades later, and the situation has only worsened.

Studies indicate that less than one in ten adults in this country are metabolically healthy. The previous director of the FDA, Robert Califf, described the public health situation regarding metabolic health as “catastrophic” back in November 2023. This isn’t hyperbole—these are serious facts.

If we don’t address metabolic ill health, we’ll continue to slow the mortality improvements we’ve been seeing for the last couple of decades. Our research shows that without intervention, the benefits we’ve gained from smoking cessation over the past forty years will be completely overrun—we’ll actually go backwards.

This is why I feel strongly about this issue. Whether you’re in the life and health industry or not, this demands our attention and action from both the industry and society in general.

R&I: What role are weight loss and diabetes-focused medications playing in addressing metabolic health issues?

NS: I want to first establish what metabolic ill health actually is: insulin resistance in the body. This is primarily driven by diet, lifestyle, and behavior choices.

Let me draw an analogy with the COVID pandemic. This was something unprecedented that required vaccines to overcome, but unlike COVID, metabolic ill health is both preventable and reversible. The biggest risk in the life and health insurance industry is having a double pandemic, something we’ve never experienced in our lifetimes.

Our healthcare system spends considerable time treating chronic conditions without addressing root causes. The medications you’re referring to deal with problems after they’ve manifested rather than preventing them. As a society and medical profession, we’ve been “hacking at the leaves, not getting to the roots of the problem.”

Insulin resistance leads to numerous health issues including Alzheimer’s disease (which some now call “type three diabetes”), fatty liver, various cancers, stroke, and cardiovascular conditions. All these conditions relate back to obesity and insulin resistance. This is what’s driving the alarming rates of obesity and type two diabetes.

Forty or fifty years ago, high-fat diets were demonized as the cause of obesity. With the benefit of three decades of research, we now understand we had it backwards. When people reduced fat intake, they often increased carbohydrates, which raise insulin levels in the body.

Add processed food to high carbohydrate consumption, and we’ve created serious metabolic problems. This isn’t about returning to carnivorous, high-fat diets—it’s about striking a balance. Our current approach isn’t preventing the problem; it’s making it worse.

I wanted to establish this scientific foundation before addressing the specific role of GLP-1 medications in this landscape.

R&I: What is the relationship between insulin resistance and the broader economic impact of healthcare conditions related to weight?

NS: There are at least 33 different medical conditions related to insulin resistance. These are what I call the “leaves” – we hack away at these or try to solve them individually.

Underneath the surface, in the ground, you’ve got root causes leading to these issues: processed food, processed carbohydrates, sedentary lifestyle, high sugar levels, lack of sleep, and chronic stress. If you address these fundamental issues, you start preventing the problems from emerging above the “landline,” where the tree and all the leaves are, rather than just hacking at the leaves.

While I’m not a medical professional, I understand enough to recognize that this impacts us all at an individual level. At a societal level, it affects the economy and the healthcare system.

The amount being spent on treating conditions stemming from type two diabetes is frightening – over $400 billion. This adds tremendous pressure to an already strained healthcare system.

I consider this a self-inflicted wound on our society.

R&I: What are the societal, economic, and individual household costs of this health issue, and why is addressing it so challenging?

NS: I’m not suggesting for one minute that this is easy to solve. If it were, we would have figured this out by now. You’re talking about changing behavior and lifestyle—whether that’s exercise, walking around the block, or the food choices you make.

These are all about changing human behavior, which we can see in so many different facets of life is extremely difficult to do. I’m not suggesting this is easy, but doing nothing is not an option.

In an industry like ours—and you could argue it’s the same for health insurance, but we’re focused on life insurance—this becomes a bit of a no-brainer. We’re all on the same side here. Whether you’re a policyholder like you and me with our own life insurance policies, whether you’re an insurer which is our client base, or whether you’re a reinsurer like us, we all want the same thing.

We want you to live a long, healthy, happy life. I’m not oversimplifying, but there aren’t many situations when you buy a product where everybody is invested in the same direction.

R&I: What is your assessment of GLP-1 medications and their impact on health outcomes and your business?

NS: This is having a direct impact on people’s lives, health, and our business. We’ve done extensive work on this ourselves. GLP-1 medications are a positive development.

I don’t want anyone to misunderstand our position – these can definitely help with weight management and adjust how people consume food. The question revolves around two main concerns: adherence and side effects. Once patients start these medications, do they stay on them?

Regarding side effects, while I’m not qualified to speak directly on medical matters, our medical professionals, including our global chief medical officer, note emerging evidence about effects on bone density, which impacts later life. There are also concerns about nutrient intake – if you don’t consume proper nutrients, you can experience muscle loss, which impacts longevity. Until we’ve studied these medications over a longer period, we cannot fully understand all potential side effects.

The increasing usage and prevalence of these medications is beneficial, though they aren’t inexpensive. Accessibility and affordability remain important considerations.

Most importantly, they should be part of a wider behavioral change. This includes adjusting eating habits and incorporating exercise – not necessarily gym workouts, but even simple activities like taking a walk after meals.

One positive trend we’re already observing is a reduction in new cases of type two diabetes, noticeable within approximately eighteen months of widespread use. While GLP-1 medications offer significant benefits, we need to view them as part of a comprehensive approach to health management.

R&I: How is a holistic approach to medical treatment more effective than simply administering medication?

NS: Rarely is the solution to any medical condition as simple as taking a pill. There’s usually more complexity involved in effective treatment.

We need to focus on the prevention side of the equation, not just addressing problems after they’ve emerged. I think GOP wants to play a role in that prevention aspect, which is an important development.

However, there’s considerably more work required to achieve significant change and reverse the high rates I mentioned earlier in our discussion.

R&I: Are life insurers evolving toward more preventative health approaches in their business models?

NS: Five years ago, I wouldn’t have been confident that we were moving in that direction. The life industry historically had a “once and done” relationship with consumers – you take out the policy, get underwritten, get accepted, pay your premiums, and theoretically, we don’t hear from you again until the end of life. This creates a missed opportunity, as there are very few products that consumers spend decades paying for with zero interaction from the provider.

I’ve been in the industry my entire career, and I find this dynamic strange as a consumer myself. I can look back over the last twenty or thirty years and count very few times I’ve heard from my life insurer. Yet they’re as invested in my health as I am.

We now have a tremendous opportunity for interventions and customer engagement. We’re starting pilot programs where we offer policyholders continuous glucose monitors (CGMs) that attach to the arm and read blood glucose levels. These devices provide personalized recommendations rather than generic advice, creating benefits for both the insurer and the policyholder.

There’s a logical role for life insurers in providing education, support, and different health programs. We’re just beginning this approach in the US, though we’ve implemented similar initiatives elsewhere for some time.

In the UK, we’ve worked with a metabolic health program for people with disability income insurance who are on claim due to metabolic ill health. We’ve helped them improve their health to return to work, essentially reversing their health conditions. This aligns with my belief that many conditions are preventable and reversible.

The good thing about type two diabetes is that it can be reversed, unlike type one which is lifelong. In our UK program running for about eighteen months, nearly half of the participants have achieved remission from type two diabetes. In the US corporate self-insured health insurance space, several companies have implemented similar programs with 50%+ reversal rates.

This isn’t hypothetical – it’s happening now. We need to make these approaches mainstream throughout the industry so that customers of life insurance companies can benefit from these experiences. As a reinsurer, we’re seeing increasing interest from life insurers in these initiatives because they create ongoing engagement with consumers.

R&I: How does the investment in greater policyholder engagement compare to the potential benefits for life insurers?

NS: For the investment we’re talking about, the cost relative to the benefit is relatively small. When you start extending people’s lives by a number of years through interventions and support networks, the payback becomes a no-brainer. It will pay for itself.

This hasn’t been the traditional role of life insurers, but that’s changing. We are very committed to this approach and quite optimistic about what we’re seeing. For both society and the industry, this represents a game changer.

We typically deal with near-term concerns—immediate economic changes, interest rate movements, and similar adjustments. Sometimes we need to take a longer view, looking five or ten years ahead. We won’t change everything overnight or immediately reverse all the incidence rates and statistics I shared earlier.

However, over time, we can make incremental differences. The benefits extend beyond just the life insurance sector. This approach is good for the economy, good for the healthcare system, and beneficial for everyone involved—there really isn’t a downside.

R&I: How is Swiss Re working with life insurance companies to address health interventions and lifestyle improvements for policyholders?

NS: For about twelve months, we’ve focused on ensuring everyone is anchored on the science, data, and exactly what we’re observing. We’re demonstrating what kinds of interventions are available through medical healthcare providers and vendors. Continuous glucose monitoring (CGM) is one example we’ve been exploring.

We’re also showing how dietary support networks can help people change their diets, potentially spending less money than before. There’s a straightforward awareness component to this work, which is why we’re having this conversation.

We want this issue to be more widely understood in both the mainstream public and the life insurance industry. We’ve been presenting at various platforms and industry events to discuss this topic. In April, I spoke to a group of advisers who sell policies about how they can help.

We encouraged them to engage with this opportunity to help improve the lifestyle of people they’ve sold policies to. It’s somewhat of a no-brainer, and they might even be able to upsell policies based on these improvements.

The goal is aligning everyone in the value chain and raising awareness. We’re implementing specific pilots with cohorts of policyholders within given companies, making tools and interventions available to see what results we achieve.

This isn’t just theoretical—we’ve seen positive results. And importantly, this issue isn’t unique to the United States; we’re seeing it in other countries, particularly in Europe, where we’re actively implementing programs and seeing results.

Early next year, we’re organizing an event called “Food for Thought” where we’ll bring together medical professionals and providers to demonstrate how these programs work. We’ll show life insurers how to implement these programs so they can take tangible actions to make a difference.

R&I: How is the insurance industry positioned to leverage its traditional role as a behavior modifier to address current health challenges? I’m recalling Benjamin Franklin telling policyholders that he wouldn’t insure their home if it was made of wood, but would do so if it was made of brick.

NS: Your analogy with wooden structures is exactly right. I go back to something I said at the beginning about the smoking crisis we had forty years ago. Society engaged with it, the life insurance industry got behind it, and we developed different rates for smokers and non-smokers because we could prove the results would pay for themselves.

For me, creating an ongoing relationship with the end consumer beyond the initial policy purchase is really important. This is a wonderful opportunity to do that.

When we talk to insurers, people are really coming around to this concept, with some further along in actually implementing changes. But this isn’t a competitive issue or about one-upmanship – it’s about something that’s good for the industry, which means it’s good for the end consumer and any active participant in the value chain.

We’re at the far end of the insurance value chain, but we have the same vested interest as a life insurance company or even the end policyholder. We want you to stick around for as long as possible and be as healthy as possible.

I recognize that discussing this in a few forums or interviews doesn’t solve the problem. We must double down and keep reinforcing the message until we achieve a groundswell of support.

There are developments outside the life insurance industry that will help this effort, including wider benefits for healthcare systems if this happens in a mainstream way. But it’s challenging, especially at the grassroots level in the United States where people have entrenched behaviors that will take time to change.

Just because something looks difficult doesn’t mean we should throw in the towel. We need to stay committed to this.

Learn more about Swiss Re at https://www.swissre.com/.

This article was produced by the R&I Brand Studio, a unit of the advertising department of Risk & Insurance, in collaboration with Swiss Re. The editorial staff of Risk & Insurance had no role in its preparation.