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ObesityWeek15

Three in four patients not covered for obesity treatments

Credit: Tony Alter
Sixteen percent of employers have wellness programmes, but many do not offer obesity treatment coverage

In one of the largest studies ever conducted to better understand insurance coverage of obesity treatments, researchers found that three out of four consumers report that they are not covered for necessary, evidence-based obesity treatment services, including access to a registered dietician (72% not covered), medical weight management (77% not covered), bariatric surgery (76% not covered) or FDA-approved obesity drugs (84% not covered). The findings were presented at ObesityWeek 2015 in Los Angeles, CA.

Theodore Kyle

“Our findings suggest that nearly 60 million adult Americans with obesity do not have access to science-based treatments for this chronic disease,” said TOS member, Dr Theodore Kyle of ConscienHealth, who led the research. “There is a clear gap in treatment; without access to obesity care by experienced medical professionals, too many Americans are being left with nowhere to turn.”

The researchers conducted the study among 9,388 anonymous, voluntary survey respondents in February 2015. All respondents answered questions about medical services covered by their health insurers, and employed respondents answered questions about employer wellness programmes with financial incentives based on weight or BMI. Descriptive statistics were calculated and analysed to identify significant patterns.

Researchers found that 16% of employees say their employers have wellness programmes focused on BMI and they offer incentives and/or penalties based on participation. However, even when employers are working to support employees’ health by asking them to reduce BMI through these wellness programmes, the employer-based health insurance often excludes obesity treatment coverage.

“Employers, many of whom may be acting in good faith, are essentially telling their workers to reduce BMI for health, while at the same time denying access to the evidence-based care that is one of the most effective ways to help them reach weight-loss goals,” added Kyle.

In a position statement, TOS recommends all wellness programmes include coverage for “responsible weight loss programmes that use evidence-based interventions” and “a supportive workplace environment that provides opportunities for employees to be healthy and practice long-term healthy behaviours.”

“We have long advocated for insurance coverage of obesity treatments, among all health plans,” said Dr Emily Dhurandhar, TOS Advocacy Chair. “We’re hopeful that this new research will shed more light on the lack of access to evidence-based obesity care by health plans, including those offered by employers with wellness incentive programmes.”

“Under the ACA, proven obesity treatments and bariatric surgery are often not defined as an essential health benefit, which means coverage by state plans varies greatly,” said Kyle. 

TOS and its partners advocate for action by federal and state governments to expand public programmes to cover these treatments, including Medicare, Medicaid and essential health benefit plans under the Affordable Care Act (ACA). Current efforts by TOS and its partners to improve treatment coverage include:

  • Treat and Reduce Obesity Act – Legislation that will provide Medicare recipients and their health care providers with meaningful tools to treat and reduce obesity by improving access to obesity screening and counselling services, and new prescription drugs for chronic weight management.
  • Access to Care Campaign – An advocacy effort by TOS to achieve coverage of the full spectrum of evidence-based, medically necessary obesity treatments within every state health exchange plan across the country.
  • Treat Obesity Seriously – A campaign by TOS to improve the treatment of obesity as a disease, and educate policymakers and healthcare practitioners on how to treat it seriously. Sign the pledge and show your support. 

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