Door in Montmartre

Barriers to Overcoming Obesity: Lack of Coverage

Ample medical evidence supports the fact that obesity is a complex, chronic, relapsing disease. Yet somehow it remains a subject of hot debates in the medical community, not to mention society at large. When it comes to treating obesity with medication, numerous insurers rely on the opinions of committees to determine which medications to cover. If some healthcare professionals don’t believe obesity is worth treating, why would we expect coverage from insurers for anti-obesity medications (AOMs)?

At the Micro Level

As an obesity medicine specialist, I see first-hand how incomplete obesity care can profoundly affect my patients. For example: a female patient in her late 60s who has struggled to lose weight since adolescence despite her best efforts. For years, she asked for help losing weight from various providers, but never felt heard. Rather, she was told the common mantra used in medicine “eat less, and exercise more.” I explained to her the body’s predisposition to be at its highest weight due to biological pressures and mis-signaling (i.e., insatiable appetite, uncontrollable cravings, etc.) over time. These signals need to be combated with other methods of biology – AOMs and/or bariatric surgery in conjunction with healthy lifestyle behaviors.

The most-suitable AOM for the scenario (liraglutide 3.0mg daily) wasn’t covered by the patient’s insurance. The next effective and safe option was off-label and cheap (topiramate 50mg daily). She lost 3% of her total body weight (TBW) with a healthy lifestyle and adjunctive AOM in a matter of three months, but felt terrible frustration. A drug exists that could help this patient to improve her health, mobility, functionality, and other weight-related conditions. Yet because of health insurance coverage policies, she could not benefit from it.

Months of discussions with her insurer and letters to rebut the coverage denial ensued. But ultimately, the patient switched carriers and gained coverage for Saxenda. It helped her lose nearly 10% of her TBW in six months.

On a Macro Level

Existing barriers to providing appropriate care for patients with obesity are unjust and biased in origin. Paying attention to obesity when treating other chronic diseases can improve weight-related medical conditions. It can make overall health and quality of life better. It seems very intuitive, but many providers are doing the exact opposite. The cost, coverage, and accessibility of anti-obesity medicines is just one reason why.

Final Words

Long-term support, behavioral therapy, and well-researched obesity medicines combine for an effective obesity-medicine treatment. We must make a concerted effort to recognize obesity as a disease and treat it like any other medical condition and advocate for legislation to encourage this.

Dr. Velazquez is an obesity medicine specialist and medical internist practicing in Los Angeles, California.

Door in Montmartre, painting by Giovanni Boldini / WikiArt

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September 28, 2021