Obesity And Weight Loss: Are Insurers Responsible?

By Pamela S. Plasterer

The Centers for Disease Control and Prevention (CDC) has labeled obesity a “national epidemic” in America, identifying it as a major contributor to some of the nation’s leading causes of death.

Certain types of cancer, heart disease, stroke and diabetes all have links to obesity. Insurance companies are taking a closer look at how they can help policyholders find new ways to lose weight, adopt a healthy lifestyle and live comfortably.

The Wallop of Weight Gain on the Wallet

Reuters reported in 2012 that the estimated annual medical costs related to obesity in the U.S. were $190 billion. Taken collectively, that figure is staggering, but the numbers are even more concerning when examined individually. According to the CDC, obese people spent an average of $1,429 more in medical costs that year than those who maintained an ideal body weight for their gender, age and height.  

According to new data from The Partnership to Fight Chronic Disease, “… if current trends continue, 43 percent of U.S. adults will be obese and obesity spending will quadruple to $344 billion by 2018.” There is hope, however. “… [I]f obesity rates are instead held at current levels, the U.S. would save nearly $200 billion in health-care costs.”

Obesity’s Heavy Toll

Most states currently do not require screening or treatment of obesity in adults and children even though it may be available through private insurance, Medicaid and Medicaid’s Early Periodic Screening, Diagnosis and Treatment (EPSDT) Program.

Information from the National Library of Medicine/National Institutes of Health, however, indicates that this may be changing.

States are beginning to consider the dire economic impact that the growing obesity problem will create. Insurance companies, too, are realizing that a decrease in obesity rates means a decrease in medical costs. Helping people lose weight before the obesity threshold is reached may prevent astronomical health-care costs in the future.

Balancing Benefits and Costs

The solutions to weight loss are out there. Nutritional counseling, pharmacology programs, fitness initiatives and bariatric surgery are just a few of the many avenues available for achieving weight loss. Insurance companies must weigh the costs of such treatment programs (which can vary greatly) against their sustained benefits and the impact these benefits could have on long-term health care expenses.

Under the Affordable Care Act, some states must include coverage for bariatric surgery in all individual, family and small group plans. Bariatric surgery offers substantial long-lasting weight loss effects and lessens the chance of acquiring the diseases and adverse health conditions related to obesity. Meanwhile, research has shown that even a 5 percent loss in weight achieved by nutrition/diet, exercise and medications can lead to improvements in blood pressure, glucose levels and cholesterol levels, according to the Obesity Action Coalition. More important, those improvements — if sustained — can last for many years.

Some insurance coverage includes reimbursements for clients who routinely enroll in fitness programs or nutritional counseling. In the end, insurance companies will need to take a close look at these initiatives, and balance premiums and expenses with projected health-cost savings.

As the threat of obesity on America’s health care increases, the research and data available to determine the cost benefits of weight-loss programs will need to increase, as well. This in turn should provide insurance companies with the information necessary to offer fair, but solvent and individualized weight-loss coverage for clients.

Pamela S. Plasterer, CIC, is the president of Ruhl Insurance, an independent agency located in Manheim, Pa. Pamela may be contacted at [email protected].