Multiple state employee healthcare plans have reduced obesity treatment services for workers in the past five years, according to research by the STOP Obesity Alliance at the George Washington University Milken Institute School of Public Health. The findings, ‘Coverage for obesity prevention and treatment: analysis of state employee health plans and use of benefits’, published in the journal Obesity, provides a stark contrast to STOP's previous research that demonstrated a promising upward trend between 2009-2017 in obesity care coverage by state insurance plans.
STOP's recent analysis examined state health coverage changes among three recommended forms of obesity treatment: nutritional counselling, pharmacotherapy (or anti-obesity medications) and bariatric surgery. Only one state added bariatric surgery services since 2017. However, the researchers identified 12 states that eliminated pharmacotherapy or nutritional counselling coverage within the last five years. Even in those circumstances where all three treatments are made available to workers, available utilisation data indicates a dramatic underuse of these potentially life-saving interventions.
The researchers report that all 50 states provided coverage for prevention and screening, 42 states provided coverage for nutrition counselling, 44 states covered bariatric surgery, but only 16 states provided coverage for pharmacotherapy treatment of obesity.
"Obesity is a complex and chronic disease, which is why patients need access to a suite of options in treating it, and we know insurance is the gatekeeper to care,” said William Dietz, Director of STOP and Chair of the Sumner M Redstone Global Center for Prevention and Wellness at the Milken Institute School of Public Health. “After years of progress, it is alarming that state employee healthcare plans are further behind now than they were five years ago.”
State governments are often a state's largest employer and because obesity afflicts more than 42% of adults in the US, this state-by-state analysis reflects the growing gulf between the pressing need for comprehensive obesity care and what is available to state employees.
The key findings were:
Obesity-related health insurance offerings for state employees have decreased in the past five years and are inadequate given the prevalence, severity and costs of obesity.
Since 2017, three state employee health plans have added nutrition counselling coverage, while three states have cut nutrition counselling coverage. Meanwhile, Wyoming was the only state to add bariatric surgery coverage between 2017 and 2021.
In 2021, states were far less likely to provide coverage for pharmacotherapy than they were in 2017, with only 16 states providing access to this treatment, despite research indicating that certain medications are approaching the weight loss success of bariatric surgery.
Coverage use data from states that shared complete data sets demonstrated a significant underutilisation of available, effective treatment services. The Texas State Employee Retirement System, for example, which enrols over 429,000 people, reported the following utilization data:
Only 2,526 patients (0.59% of plan enrolees) received some type of nutritional consultation;
Only 39 patients (0.01% of plan enrolees) received bariatric surgery;
Only five prescription drug claims were issued in all of PY2019
Despite continued efforts, obesity coverage among state-funded health insurance plans remains piecemeal and inadequate.
"Our research presents a call to action for state governments and labor advocates to renegotiate healthcare contracts with their insurance providers," said Samuel Hughes, lead author, a graduate of the GW Law School and former Redstone Center Research Assistant. "We need to reclaim momentum for a continuum of obesity care and support efforts for expanded health coverage in every state. By investing in evidence-based treatments now, we can spare workers the harms of illnesses associated with obesity - such as diabetes, liver disease, heart disease, and certain cancers - and quite frankly, save states money."
To improve the treatment and management of obesity, coverage must be expanded. To do this, the STOP Obesity Alliance has made the following recommendations:
identify model obesity treatment coverage plans, and when coverage is available, assess the utilisation of benefits
encourage patients to demand coverage from their health plans and employers
continue to advocate for expanded coverage from state employee health plans at the state capitols; and
increase studies of the return on investment to health plans and employers from covering all obesity treatment modalities.
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