Closing the Gap in Obesity Treatment?

Policymakers urging people with obesity to do something about it are a dime a dozen. And most people with excess weight would dearly love to do something about it. Largely out of their own pockets, Americans spend more than 50 billion dollars on products and services for controlling their weight. But the real problem is a gap in obesity treatment access — access to options that might really help

Evidence-based options for treating obesity — behavioral therapy, obesity medicine physicians, drugs, and surgery — have historically been excluded from coverage by most health plans. Only about a quarter of adults report that they have health insurance that will pay for any of them.

We are seeing progress. Coverage for obesity drugs is slowly improving. Bariatric surgery is covered by many health plans — both government and private — despite some onerous limitations and irrational conditions for coverage. The biggest recent change has been the designation of intensive behavioral therapy (IBT) as an effective preventive care measure. This determination is prompting Medicare and private insurance providers to cover IBT, or at least act like they do.

In a commentary published by the American Journal of Medicine, Gary Bennett and colleagues point out how inadequate this progress has been. Their focus is on people most affected by obesity — high risk populations, racial and ethnic minorities, and socioeconomically disadvantaged populations. They describe unwise limitations on who can provide IBT services and a provision that would cut off coverage for people whose obesity is particularly difficult to treat. The paper concludes by saying:

While no reimbursement policy can be fully comprehensive, these strategies should be weighted towards those with greatest need. The current reimbursement policy does not appear to meet that test.

If policymakers are serious about addressing obesity, they will act now to close the gaps in access to care for obesity.

Click here to read the commentary in AJM and here to read an op-red from the Minnesota Daily.

Indian Gap School, photograph © Sandra / flickr

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