Obesity rates are soaring in the United States, contributing to serious health risks and diseases.
Yet in many states, plans sold in new health insurance exchanges beginning this fall will not be required to cover weight-loss surgery, prescription drugs and other treatments used to treat obesity.
The Patient Protection and Affordable Care Act mandates that obesity screening and counseling must be covered by all health insurance plans sold in each of the 50 states and the District of Columbia.
However, follow-up care does not fall within the scope of that mandate, says Dr. Wayne English, medical director of the Bariatric and Metabolic Institute at Marquette General Hospital in Marquette, Mich.
"Unfortunately, the treatment that is required thereafter is not covered," English says, who also is chair of the Access to Care Committee at the American Society for Metabolic and Bariatric Surgery (ASMBS).
Instead of mandating coverage of obesity treatments, the federal government is leaving it up to the individual states to decide which types of obesity care health insurance plans must cover.
More than one-third of U.S. adults are obese, according to the Centers for Disease Control and Prevention (CDC). Obesity is closely linked to several health conditions, including heart disease, stroke, Type 2 diabetes and some forms of cancer.
State requirements for obesity treatment
Health care reform requires that citizens and permanent residents in all 50 states and the District of Columbia have the opportunity to purchase health plans in new marketplaces known as health insurance exchanges.
The nation's new exchanges will open for business on Oct. 1 2013, and policies sold at that time will go into effect on Jan. 1, 2014.
Some states are setting up their own exchanges. Other states either will partner with the federal government in setting up an exchange, or will cede control to the federal government altogether.
At this time, 23 states are requiring that health insurance plans sold on health exchanges cover metabolic and bariatric surgical procedures, according to the ASMBS.
Such procedures are intended to help obese patients lose large amounts of weight, and include adjustable gastric banding, gastric bypass surgery and vertical sleeve gastrectomy (a surgical procedure where the stomach is reduced to about 25 percent of its original size).
Meanwhile, just four states – California, Massachusetts, Michigan and New Mexico – and Washington, D.C., are mandating coverage of weight-loss treatments. These treatments vary by state, but include things such as hospital-based weight-loss programs, nutrition counseling and reimbursement of health club membership fees.
The individual state rules regarding obesity treatment only apply to health plans sold on health insurance exchanges, English says. Health insurance companies still can bypass exchanges and sell health insurance directly to individuals.
Reaction to coverage rules
Obesity advocacy and education groups are urging more states to include weight-loss treatments in the list of benefits plans must cover.
The five states with the highest rates of obesity are Mississippi, Louisiana, West Virginia, Alabama and Michigan, according to the CDC. Of these states, only Michigan and West Virginia will mandate coverage of weight-loss surgery, and only Michigan will mandate coverage of weight-loss treatments.
"It is important that obesity treatments such as bariatric surgery are available to the public," says Christine Stewart-Smith, a spokeswoman for National Bariatric Link, an organization that matches patients with bariatric surgeons.
She notes that the cost of such surgery can reach $20,000, making it cost prohibitive unless it’s covered by insurance.
Joe Nadglowski, president and CEO of the Obesity Action Coalition advocacy organization, says that he’s disappointed the federal government hasn’t been more aggressive in pushing states to cover obesity treatments.
"Both Congress and the administration have failed to include any specific guarantees regarding coverage of obesity treatment services," he says.
Nadglowski says obesity is a complex condition that impacts both physical and mental health. Limiting the scope of health insurance coverage makes it less likely that patients will receive the comprehensive care they need, he says.
"Effective treatment requires the coordinated services of providers from severaldisciplines and professions," he says.
English believes it is short-sighted not to guarantee more widespread coverage of obesity treatments. He notes that obesity is a major contributor to many health conditions that are costly to treat.
According to the CDC, conditions related to obesity include:
• Heart disease
• Type 2 diabetes
• Cancers of the endrometrium, breast and colon
• High cholesterol
• High blood pressure
• Liver and gallbladder disease
• Sleep apnea
• Gynecological issues such as abnormal menses and infertility
How to prevent obesity
Of course, it is much better to prevent obesity before it causes health problems. The U.S. Department of Health and Human Services offers the following tips for obesity prevention:
• Eat healthy foods and limit portion sizes.
• Exercise regularly.
• Reduce time spent in front of TVs, computers and video game screens.
• Keep track of your weight, waist circumference and body mass index (BMI), a number calculated from weight and height than can indicate whether or not you are obese. The CDC has calculators that can help both adults and children track their BMI.