Expansion of Care for People Living with Obesity

Centrifugal Expansion of ColorsA landmark expansion of access to medical care for people with low incomes is more than a decade old now. Where politics have not gotten in the way, Medicaid expansion clearly has had a broad effect on health in America. But something that’s less obvious is the benefit of a quiet, though uneven, expansion of access to care for people living with obesity. A new paper in the journal Obesity tells the story.

The Broad Effects

In Health Affairs, Olena Mazurenko and colleagues published a systematic review of outcomes from Medicaid expansion. They found that under this aspect of the Affordable Care Act, coverage improved, people gained more access to care, and their quality of care improved.

More recently this year, a study in Lancet Public Health tells us that reductions in all-cause mortality followed on from Medicaid expansion. They found that these results varied among different states enacting the expansion. States with larger populations of uninsured and Black persons saw the bigger benefits. In these results, the authors see potential to bridge health disparities across the wealth spectrum.

For People Living with Obesity

With their new study in Obesity, Karla Kendrick and colleagues found significant improvements in access to care for people living with obesity. Numbers of people without a usual source of care went down. So, too, did cost as a barrier to medical care. But there is a catch. They found that the benefit of Medicaid expansion was evident for White adults with obesity – not for Black and Hispanic persons with it.

This is a puzzling finding that raises important questions. One of the authors, Fatima Cody Stanford, describes the problem:

“​As obesity rates continue to climb in the United States, certain groups bear a more significant burden – racial and ethnic minority populations and those from lower socioeconomic status.”

So while it’s clear enough that Medicaid expansion brought important benefits in access to care for low income persons and for some people living with obesity, it’s not clear that those benefits were uniform.

We know that significant racial and ethnic disparities exist and persist in effects, care, and policies related to obesity. Thus, these gaps in the effects of Medicaid expansion for Black and Hispanic persons with obesity raise important questions.

Medicaid expansion may be moving into more states that have resisted it before. So the time is right to find how its benefits can be realized more equitably for people living with obesity.

Click here for the study in Obesity, here for the study in Lancet Global Health, and here for the systematic review in Health Affairs.

Centrifugal Expansion of Colors, painting by Gino Severini / WikiArt

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September 6, 2022