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ObesityWeek 16

Insurance and diagnosis are barriers for obesity treatment

Less than half of patients with obesity are diagnosed in the medical setting

Improving health insurance coverage for weight loss services could help people struggling with obesity lose weight, according to a survey of non-physician health professionals (HPs). It is believed to be the first study to examine HPs perspectives of insurance coverage as a facilitator or barrier for weight loss. In addition to current insurance coverage being perceived as a barrier, a second study found that three out of four patients are affected by obesity or overweight, yet less than half (48%) of these patients with a BMI higher than 30 received a formal diagnosis of obesity.

“These two barriers to care – no insurance for medical weight loss support and lack of initial diagnosis – can negatively impact people with obesity or overweight as they seek support from those most adept, trained weight-loss professionals,” said Scott Kahan, spokesperson for The Obesity Society (TOS) and director at the National Center for Weight and Wellness. “While self-management strategies, such as following a commercial diet or increasing exercise, can help in some individuals, most people with obesity, especially those with severe obesity, can benefit from a comprehensive approach that includes healthcare professional support.”

In her presentation, “Health Professionals’ Perceptions of Insurance Coverage for Weight Loss Services”, Dr Ruchi Doshi, MPH at the Johns Hopkins University School of Medicine and the Johns Hopkins Bloomberg School of Public Health, explained the first objective of the researcher was to determine whether HPs perceptions of insurance coverage-related challenges and solutions, and to examine whether these perceptions varied by patient panel income level.

Doshi and colleagues conducted a cross-sectional, web-based survey of HPs in nutrition, nursing, behavioural/mental health, exercise, and pharmacy. Our outcomes were HPs’ identification of insurance coverage as a top three (1) “challenge” or (2) “solution” for obesity management and weight loss.

Among 450 weight management HPs (mean age was 44.9 years; 86% were women; 44% had low-income panels), 23% of HPs endorsed current insurance coverage as a challenge and 57% viewed improved coverage as a solution. Relative to HPs with non-low-income panels, HPs with low-income panels had similar predicted probabilities of identifying insurance coverage as a challenge to care (28% vs 20%, p=0.33) and viewing future benefits expansions as a solution to improve outcomes (47% vs 64%, p=0.08).

“More than half, 57%, of the 450 health professionals we surveyed believe that improved health insurance coverage for weight loss is a solution to greater access to care, and this finding cuts across all patient income levels,” said Doshi. “Furthermore, we found that a quarter of health professionals perceive current insurance coverage to be a weight-loss challenge.”

“Regardless of panel income level, most HPs perceive insurance coverage of their services as an important factor in facilitating weight loss,” she concluded. “While the Affordable Care Act potentially expands coverage of obesity care to low-income patients, there is no legislation regarding benefits for non-governmental insurers; yet health professionals perceive that all patients may benefit from expanded coverage.”

The second study, “The Prevalence and Recognition of Obesity and its Associated Comorbidities in a Large U.S. Integrated Health System,” Dr Bartolome Burguera of Cleveland Clinic’s Endocrinology and Bariatric Institutes and Director of Obesity Programs at Cleveland Clinic examined the initial diagnosis of obesity.

Funded by Novo Nordisk, Burguera and his colleagues reviewed nearly 325,000 electronic health records from the Cleveland Clinic to see if patients with obesity or overweight as identified via BMI received a formal diagnosis using ICD-9 documentation. This cross-sectional summary from a large US integrated health system found that of all patients with a BMI > 30, only 48% had documentation of an ICD-9 code for obesity. In those patients with a BMI > 40 (considered severe obesity), only 75 percent had an ICD-9 code for obesity.

“The disease of obesity is very prevalent yet too often underdiagnosed, which could be an important barrier to getting initial care,” said Burguera. “By providing a formal diagnosis, we may be able to help people get the treatment they need to lose weight and get healthy. The under diagnosing of obesity may serve as an important barrier to treatment initiation.”

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