Insurance Coverage is Lagging in a Golden Age of Obesity Treatment


Antiobesity medications are considered to be 'vanity drugs' by many private insurers, and the refusal to cover obesity treatment is counterproductive because of obesity's many health consequences.

Antiobesity medications have been all over the news and social media lately, and although normal weight celebrities’ use of Ozempic (semaglutide) to quickly lose 10 pounds is not recommended practice, this new visibility does highlight how far obesity medicine has come in recent years.

Semaglutide (branded as Ozempic for diabetes and Wegovy for obesity treatment) can help patients lose up to 15% of their body weight, while other medications in the pipeline are even more promising. Considering that weight loss of just 5%-10% can have measurable health benefits (improving blood pressure and blood sugar, for example), these new medications have game-changing potential. In addition, we have more data about the effectiveness of other interventions, and new digital tools that allow us to target treatments to individuals’ needs more precisely.

But despite all this progress, the vast majority of the 42% of American adults with obesity aren’t being treated. Although the American Medical Association recognized obesity as a complex chronic disease in 2013, only 7% of people with obesity are diagnosed and recommended for treatment.

Three key barriers are preventing access to care.

First, stigma. People with obesity often avoid healthcare settings because they’re tired of always being told to just eat less and exercise more when that doesn’t work for them. The popular belief that weight gain is all about calories-in versus calories-out — and that people with obesity lack willpower — isn’t supported by the science. Some people with obesity can lose weight with diet and exercise alone, but more than two-thirds can’t, because of all the physiological mechanisms the human body has evolved to fight weight loss. Yet the outdated view of obesity as a lifestyle issue remains along with the stigma it fosters.

A second barrier is the shortage of providers to treat obesity. Historically, most medical schools have offered little training in obesity care. This oversight is slowly being addressed, but the change will take time to work its way through the system. In the meantime, digital health technologies such as remote monitoring and video visits can help current providers treat more patients more efficiently. Virtual care works well in obesity medicine, because much of what we do involves taking detailed histories to identify all the factors contributing to weight gain, creating a highly personalized weight management plan and providing ongoing supportive management.

It’s time-consuming work, and this brings us to the third barrier: lack of insurance coverage for obesity treatment. Primary care providers need to be paid for the time they spend treating their patients’ obesity. Often, though, only the specialists who treat the 200 and more conditions caused or worsened by obesity — high blood pressure, type 2 diabetes, sleep apnea, etc. — are eligible to be reimbursed. Only a minority of health plans cover nutrition and behavior change counseling. They are necessary components of a weight management plan, but they’re usually not enough on their own. Most people with obesity need comprehensive, long-term treatment that includes medications.

Coverage of medications is even more limited, though. Many private insurers consider antiobesity medications to be “vanity drugs,” while some government-funded insurance programs — most notably Medicare — are prohibited by law from covering weight management medications.

This refusal to cover obesity treatment is counterproductive. Obesity is responsible for $173 billion in additional medical costs per year in the U.S. It would be more cost effective for insurers — not to mention better for patients — to treat the underlying obesity before other weight-related complications develop. It doesn’t make sense to refuse to cover someone’s semaglutide prescription until they develop diabetes, or to not pay to treat their obesity until they qualify for bariatric surgery.

Fortunately, perceptions of obesity are evolving, and efforts to change the Medicare law — a critical step in shifting the insurance landscape — seem to be gaining traction. The Treat and Reduce Act proposes expanding Medicare’s coverage of intensive behavioral therapy for obesity and allowing coverage of weight management medications under the Medicare Part D prescription drug benefit. Because private insurers often follow Medicare’s lead, this legislation would ultimately affect even more than the 50 million individuals enrolled in Medicare Part D.

The science tells us that obesity is a disease that requires medical care, and we have the tools to provide this care. We’re in a golden age of obesity treatment — we just need to expand access. Eliminating stigma and training more healthcare providers are both important longer-term projects, but expanding insurance coverage for obesity treatment could have an immediate impact on the health and well-being of tens of millions of Americans. Let’s make it happen.

This article originally appeared on Managed Healthcare Executive.

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