Intentions, Appearance, and Health in Obesity

Let’s talk about lame excuses for denial of care in obesity. Writing in Quartz yesterday, Analisa Merelli explained the challenge obesity treatment presents for health insurer. The challenge comes down to this: “The line between healthcare and lifestyle can be blurry.” In this way of thinking, insurance companies must decide if the intentions are right – does the person with obesity care more about appearance or health?

This brings to mind a 17th century test for witchcraft, “swimming” the purported witch. Tie up the accursed and throw them into body of water. If they survive, they must be a witch. If they sink, their hearts must be pure and their death can be mourned.

Scared by the Unmet Medical Need

But let’s be clear. The real problem is not the intentions of a person seeking care for obesity. The common exclusionary language in health insurance policies makes the point: coverage is excluded “regardless of medical necessity.” Insurance prefers not to pay.

The reason is simple. The unmet medical need is daunting. Many people have been living with a significant burden of obesity for a long time, having concluded that efforts to treat it are futile. The options lave been limited and not very effective. So most people just live with it and its consequences: diabetes, heart disease, liver disease, and a range of cancers triggered by obesity. Of course, health insurance covers those costly problems. Employers who pay the bills for health insurance find it much easier to wag fingers at people with obesity – and tell them to lose weight – than to cover treatment for the condition.

“It’s not something that’s likely been budgeted for,” says Cody Midlam of the health benefits consultancy Willis Towers Watson. So yes, it’s all about the money.

Better to Have an Invisible Disease

In this way, it might be better to have an invisible condition – like hypertension. With high blood pressure, an employer or health insurer can’t so easily single out people for having the wrong intentions, lifestyle, or wanting to improve their appearance more than their health – as they do with obesity. For hypertension, these are moot questions.

As they should be for access to care for obesity.

Click here for more from Merelli in Quartz and here for more on why your employer doesn’t want to pay for obesity treatment from the Wall Street Journal.

Dunking, illustration by John Ashcroft / Wikimedia Commons

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May 30, 2023