Obesity is a leading cause of poor health, early mortality, and a significant cost driver in the US health system. Forty-two percent of people in the US are obese—an increase of more than 10 percent since 1999, costing the country roughly $173 billion dollars per year. These rates of obesity are higher among blacks and Latinos, people with lower levels of education and income, and those between the ages of 40–59. Obesity is persistent and pervasive, but reducing weight by as little as 5 percent can result in better health. So, access to effective treatments to help people lose weight can result in better health and health system finances. Treatment for obesity has evolved in the last 10 years, including with medication, surgery, and counseling enabled both through live contact and digital technology. Many of these interventions yield weight reductions of 5 percent or greater in clinical study, yet they are not broadly covered by insurance and are used by only a tiny minority of people who could qualify for treatment.

Recently, I spoke with Joe Antos, Donna Ryan and Michael Albert about the evolution of treatments for obesity. In our panel discussion sponsored by AEI, we compared the progress of obesity science to the evolution of policy and practice to provide access to obesity care. We discussed the historical foundation for the lack of insurance coverage for obesity treatment and what this means for providers who treat people with obesity, healthcare systems, and patients. We considered the potential costs and benefits from expanding access to obesity treatment and how these may be viewed by policymakers responsible for budgets and services. In this post, I summarize some of the key points from that discussion.

Historically rates of treatment for obesity have been low. This may be related to stigmatization and misconceptions about the disease or a limited array of treatment options. However, there is a growing body of evidence that affirms that obesity is a disease that is not solely attributed to lifestyle and discipline. These scientific advancements in understanding of the etiology of the disease challenge perceptions that treatment is a matter of “willpower” or a change in lifestyle. The understanding of the disease has grown and there are new treatments to help people reduce weight. As evidence of the potential benefits of obesity management have grown, some organizations including the Veterans Administration with its MOVE! program and the Office of Personnel Management (in their call letters to potential insurance providers for federal employees) have made efforts to provide broader access to medicine, counseling, and surgery. So have some states offering treatment coverage in Medicaid, through their regulation of small group insurance markets and in-state employee benefits. These measures increase access to diagnosis, treatment, and follow-up care for obesity. However, obesity treatment coverage is highly variable across insurance types, and medication is notably absent from Medicare part D which serves 64 million people but was established with a specific exclusion for obesity drugs.

Furthermore, in-Medicare counseling is reimbursed when delivered by a healthcare professional; while there have been some advancements within billing codes allowing for alternative care delivery and technology, the uptake of these codes among service providers is low. While it is generally expected that federal regulations lag behind scientific and medical innovations, the result is that clinicians are unable to effectively treat the disease due to the lack of coverage.

It is challenging to accurately predict the cost effectiveness of treatment for years and even decades in the future when these treatments could reduce costs, and costs of care occur today in a strained budget environment. In a fee-for-service health system, spending today to save money through improved health tomorrow is not particularly a benefit to many stakeholders, except for the patients who don’t hold budget responsibility.

The advancements in obesity treatment over the past few decades are numerous; however, there is still a lot of room for improvement. Obesity metrics like BMI are outdated and do not accurately measure obesity. Technological imaging advancements show promise as more reliable and sensitive methods to measure obesity, which could change the diagnostic standard. Additionally, technological advancements in the interoperability of patient records could provide research to inform best practices for obesity treatment. Furthermore, there are not enough providers with training specific to obesity. With only around 5,000 board-certified obesity specialists, most obese patients receive care from a primary care provider. Left untreated, obesity will continue to drive costs and poor health. Expanding coverage to care is sure to have a cost as well, and policymakers and the private sector should seek out the evidence to determine if the benefit outweighs the cost, considering that benefits go beyond federal healthcare budgets: patient wellbeing has a value, too.

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