Calling obesity a disease could affect health insurance
Last Updated: 173 days ago
Obesity: It's not a failure of willpower anymore.
The American Medical Association's decision to officially label obesity as a disease at its annual meeting in Chicago is raising hopes among dieticians, bariatric surgeons and internists prescribing weight loss drugs that more of their services will be covered by health insurance.
"Take the stigma away so insurers will pay!" said Leslie Bonci, director of sports nutrition at the University of Pittsburgh Medical Center, in an email after the AMA's vote was announced Tuesday.
But local insurers reacted more cautiously. "I think the standards are not going to change for right now," said Dr. Carey Vinson, vice president of quality and medical performance management at Highmark Health Services, based in Pittsburgh.
The AMA pronouncement isn't going to affect coverage decisions -- allowing weight loss surgery for those who are on the lower end of the obesity scale, for example -- but conclusive medical research, gathered and disseminated over time, will, he said.
"I think it's a little early," added Dr. Stephen Perkins, senior medical director for UPMC Health Plan in Pittsburgh. The AMA's statement, taken in context, was aimed at increasing awareness in physicians about obesity's risks to the overall health of the patient, "but the AMA making a statement doesn't automatically change our benefit structure."
Perkins also said that if you took a poll of local doctors about the AMA's pronouncement, "you would not get 100 percent agreement" that obesity is a disease.
Indeed, within the AMA, there was opposition to labeling obesity a disease. In a report, the organization's Council on Science and Public Health said "obesity results from personal choices to overeat or live a sedentary lifestyle."
If only it were that simple, said Daniel Gagne, a bariatric surgeon at West Penn Allegheny Health Care System in Pittsburgh.
"The whole notion that anyone who is overweight is just being lazy and overeating is not true," said Gagne, noting that he'd seen a patient Wednesday morning who weighed 400 pounds. "Some people are cursed with bad metabolism, they try to lose weight and it's very frustrating. It's a misconception that it's just about willpower."
Currently, obesity in adults is defined as having a body mass index, or BMI, of 30 or higher, a figure that is calculated by measuring body fat based on height and weight. Most insurers won't cover bariatric surgery, however, unless a patient has a BMI of 40, or 35 if other conditions, such as sleep apnea or diabetes, are present.
There are currently two weight loss drugs, both appetite suppressants, that insurers will cover, called Qsymia and Belviq.
"They're to help you get started on a weight loss program, but we don't recommend taking them in isolation," said Marc Itskowitz, a primary care physician in Pittsburgh whose practice mostly deals with problems caused by obesity. Some insurers, he noted, require a pre-authorization, a form completed by the doctor specifying the criteria for the medication.
Then there's diet and nutrition counseling, which often are categorized as a "lifestyle" benefit and not usually covered by private insurers.
Other changes in thinking about and paying for treatment for obesity may come soon, but not just because but the AMA has declared one third of all Americans -- the number estimated to be obese -- are sick, said Highmark's Vinson.
Rather, insurers make decisions based on a critical mass of studies indicating the need for a change in policy, he said. "I think over time, with more research and agreement as to what the parameters are" that define obesity, there will be adjustments, Vinson said, "but right now, based on what the AMA said, there will not be much change."
(Contact reporter Mackenzie Carpenter at firstname.lastname@example.org. Distributed by Scripps Howard News Service, www.shns.com.)
Copyright 2013 Scripps Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.