The government will finally cover obesity care for its employees — but not the rest of us
Obesity is a complex disease that is poorly understood by the public. Unfortunately, treatment of this disease is hampered by societal misconceptions and discriminatory beliefs that confuse appearance with disease. Recent media coverage and the popularity of new anti-obesity medications (AOMs) have increased confidence in seeking treatment for this disease. But most people still can't get health care because their insurance won't pay for it — unless you're a federal employee.
That's right, starting this year, all health plans serving federal employees must provide AOM coverage. In rolling out this new guidance, the Fed was very clear – emphasizing that “obesity has long been recognized in the United States as a disease affecting children and adults” and that “obesity is a complex, multifactorial, common, serious Chronic, recurring and costly disease is a major risk factor for diseases such as heart disease, stroke, type 2 diabetes, kidney disease, nonalcoholic steatohepatitis and certain types of cancer.”
While this is great news for more than 8 million federal employees, retirees, and their families, it still misses millions of other Americans who could benefit from comprehensive obesity care — especially those receiving the Affordable Care Act 》 Provides government program services (commonly known as ObamaCare) and Medicare. For example, many state health exchange programs administered by Obamacare currently do not cover any obesity- or weight-loss-related treatments—even if those treatments help obesity-related medical conditions. Medicare, our nation's federal health insurance program for seniors, continues to exclude AOM coverage under regulations passed more than 30 years ago.
For generations and even today, obesity has been considered a lifestyle choice that can be fully regulated through diet and exercise. While diet and exercise can help you lose weight, they are not effective in maintaining weight loss for most people. These lifestyle interventions are more successful if accompanied by intensive behavioral counseling, medication, and/or surgery. The most worrisome thing about obesity has nothing to do with how you look, but how it affects your health. Obesity and related diseases are the second leading cause of preventable death. About 70 percent of Americans are affected in some way by the disease.
Obesity medicine experts are more willing than ever to treat the disease. For example, the recently launched anti-obesity drug Wegovy is a game-changer. It reduces hunger and increases satiety by boosting hunger-related hormones. Studies have shown that more than 85% of participants who took the drug lost weight and kept it off. Surgical procedures, such as metabolic and bariatric surgery, have been the gold standard for treating severe obesity. New scientific guidelines were recently announced to expand indications for surgery so more people can be helped early in the disease. In short, healthcare professionals now have a whole range of options for treating obesity.
I applaud the federal government for taking care of its own employees and providing obesity care insurance — but I question why so many Americans served by other federal programs are left to fend for themselves. Congress must act this year to end a three-decade discriminatory ban on Medicare by reintroducing and passing legislation such as the Treating and Reducing Obesity Act (TROA), which would allow coverage of obesity drugs and allow more of healthcare professionals provide intensive behavioral therapy for obesity. Congress should also work with the White House to modernize the federal guidelines governing the Obamacare health program to ensure that obesity is treated as a chronic disease—as an essential health benefit worthy of inclusion in a comprehensive treatment pathway.
More than 9 percent of U.S. gross domestic product is spent treating the consequences of obesity. In the United States, approximately 500,000 people die each year from causes ultimately caused by obesity.
It's time to dispel the myth that diet, exercise, and willpower alone can solve this health crisis. It is time for all public and private health plans to follow the example of the Federal Employees Health Plan and standardize obesity treatment care.
Shauna Levy (MD, MS, FACS, FASMBS, American Board of Obesity Medicine Diploma) is an assistant professor at Tulane University, an obesity medicine specialist, bariatric surgeon, and medical director of the Tulane Bariatric Center. Levy is the Louisiana State Nursing Representative (STAR) for the American Society of Metabolic and Bariatric Surgeons. Follow Levy on Twitter: @Smlevy82
