Should insurers cover obesity now that AMA says it’s a disease? [Detroit Free Press]

July 22--Michigan's heaviest patients may one day be better able to tap into medical help for weight loss after a decision last month by the American Medical Association to designate obesity as a disease.

"It's a long time in coming," said Dr. Wendy Miller, director of the Weight Control Center at Beaumont Hospital</org> in Royal Oak.

She and others said they hope the AMA's decision may pressure insurers to step up coverage for the treatment of obesity itself, rather than covering only its fallout -- hypertension and diabetes and joint pain, for example.

Consider that U.S. hospitals charge an average of $29,517 for bariatric surgery and immediate follow-up, according to NerdWallet, a San Francisco-based consumer website that compares costs for medical procedures, personal finance and other services.

While some insurers cover weight-loss plans or offer policies that reward consumers for meeting certain health benchmarks, coverage for costlier weight-control procedures is far from guaranteed.

For insurers, it is an issue of absorbing big costs for medical measures that may or may not mean cost-savings in the long run.

Others question calling obesity a disease when that spare tire often is based on bad choices -- reaching for french fries instead of veggies, or the TV remote instead of gym shoes.

"The obesity epidemic is a result of lifestyle changes that have lessened exercise and increased consumption of calories, mostly from foods rich in sugar and fats," said Dr. Kenneth Fisher, a Flint doctor and president of the Michigan Chapter Docs4PatientCare, an organization that formed to oppose the federal health care reform law.

"Another problematic lifestyle in this country is gun violence," Fisher said in an e-mail. "Should this also be designated a disease?"

Dr. Charles Burant, of the the Michigan Nutrition Obesity Research Center at the University of Michigan, also questions the AMA's decision.

To him, carrying extra weight is not a disease, in and of itself. Rather, it's a risk factor that leads to heightened risk for disease -- type 2 diabetes, hypertension, cardiovascular disease, arthritis, infertility and some cancers, among others.

To be clear, Burant's not saying fighting obesity is easy. Not at all.

The human body is primed to accumulate nutrients. In today's world, food is plentiful, including foods that "have been engineered to get us to crave more," he said.

In other words, obesity isn't a malfunction of the body; rather, "we're fighting against our environment," he said.

No matter what you think of as the cause of obesity, Michelle Pierce asks that you consider a few numbers:

-- 335 pounds: What she weighed in 2011.

-- 180 pounds: What she has lost since bariatric surgery.

-- 28: What size she wore before her current size 6.

Yes, she acknowledged, no one forced the ice cream into her shopping basket several years ago. But after four years with cancer, her mother had died at the St. Clair Shores home Pierce shared with her parents.

"I was trying to bury my grief," said Pierce, 44.

Add to that, life's typical changes.

Pierce no longer went dancing with friends as she had done years earlier. A new job took her from walking a sales floor to sitting behind a desk.

Pierce said she believes the surgery in September 2011 helped her avoid immeasurable costs for medications, doctor's visits and medical procedures.

The most important numbers, she said, are the ones she has not memorized, but they are in her medical charts: better blood sugar levels and blood pressure.

Whatever the cause of the extra pounds for her or others -- genetics, environment, psychology, behavior -- the numbers suggest that paying to control obesity saves money in the long run, said Pierce, who applauds the AMA's decision.

"I was facing diabetes, and that opens a whole Pandora's box with everything that comes with it. You don't just get diabetes. You get neuropathy and high blood pressure," she said.

While some policies fully or partially cover bariatric surgery for patients who have other medical issues, others don't. Costly weight-loss procedures don't offer the same certainty of long-term savings as, for example, an emergency surgery that prevents an imminent heart attack -- a variable for both insurers and those who are choosing among policies.

"Folks have to make a business decision: What is the return on investment?" said Rick Murdock, executive director of the Michigan Association of Health Plans.

How much the AMA's decision could cost insurers and the health care world is unclear.

Some worry that reframing obesity as a disease may drive patients and doctors toward drug and surgical fixes at the cost of less-expensive changes in diet and activity.

The AMA's decision categorized nearly one-third of Americans as diseased and another one-third as close to it.

"Once it becomes labeled as a disease, people will say, 'I need treatment other than what I can do myself,' " said Dr. Bobby Mukkamala, a Flint doctor and member of the AMA's Council on Science and Public Health, which -- citing a lack of precise definitions for "obesity" and "disease" -- recommended against the AMA's decision.

Dr. Thomas Simmer sees it differently.

As chief medical officer for Blue Cross Blue Shield of Michigan, Simmer said the AMA's move fuels the insurer's efforts at shrinking consumers' waistlines.

The AMA's new position reinforces the approach that attacking weight gain from a number of angles -- education, medical intervention, public awareness, even the doctor-patient conversation in the exam room -- heads off expensive medical problems later.

"It's sending the message to health care professionals that ... we want you to be actively engaged" in helping patients battle obesity, Simmer said.

Like the Blues, Health Alliance Plan offers incentives for those who meet certain health benchmarks, like lowering body mass index or improving cholesterol levels, and it sponsors community health programs that, in part, raise awareness about maintaining a healthy weight.

And now that the AMA calls obesity a disease?

"From our perspective, it doesn't change the way we do business," said Vernal Brand, associate vice president of HAP's Quality & Disease Management.

Whatever the outcome, AMA President Dr. Ardis Hoven said the decision has triggered a deeper public discussion on a complex issue.

And that's really what it's all about, she said: "This conversation must be had."

Calculate your own BMI

BMI For Adults Widget

___

(c)2013 the Detroit Free Press

Visit the Detroit Free Press at www.freep.com

Distributed by MCT Information Services