Coverage and reimbursement of weight loss treatments in the U.S

Despite the alarming increase in U.S. rates of obesity, dire associated health consequences, and an ever-increasing tide of obesity-related healthcare costs, health insurance coverage of obesity treatment widely varies. Although it was hoped that the 2004 Centers for Medicare and Medicaid Services (CMS) policy reversal of its previous position that obesity was not an illness would expand public and private coverage for evidence-based obesity treatments, coverage for treatment of obesity as a primary disease remains very limited. Since this policy change, only coverage for bariatric surgery has expanded, and is now routinely covered for Medicare beneficiaries who are morbidly obese with at least one comorbid illness. In contrast, Medicare coverage for dietary counseling, behavioral modification, commercial weight loss programs, and weight loss prescription medications has remained extremely limited. Bariatric surgery is covered for Medicaid enrollees in 45 states, nutritional consultation in 26 states, and weight loss drugs in only 10 states. Coverage policies of private health plans are similar. A survey of 16 private health plans in Pennsylvania covering approximately 5 million adults revealed that all plans provided some coverage for bariatric surgery, but just over half (56%) provided coverage for individual dietary counseling, and less than half for behavioral modification (44%), commercial weight loss programs (25%), and FDA-approved weight loss medications (6%).

Coverage and reimbursement of obesity treatment is an increasingly important issue, given the magnitude of the public health problem. Just as full coverage of smoking cessation programs improves both access and quit rates, expanding insurance coverage to include evidence-based weight loss treatments should improve access to and outcomes of weight loss treatments. Although bariatric surgery has been gaining popularity as an effective way to achieve substantial weight loss and halt or resolve obesity-related comorbidities, it remains an option only for the extremely obese and is associated with significant risks and costs. Access to non-surgical treatment options for the large number of obese persons with or without comorbid illnesses must be increased to impact this epidemic. Significant medical benefits can be gained even with a relatively modest (5-10%) sustained weight loss, and greater coverage may be provided as insurers realize these benefits as well as their return on investment.