Is Obesity a Chronic Disease? Yes, Although Optimal the Approach To Treatment Remains Unclear

Opinion: Lack of Access to Obesity Care Highlights Stigma and Disparity

Obesity is a chronic disease with proven treatments. But insurance and other issues block access to some such therapies, bariatric surgeons say.

February 9, 2017 1:00 PM

Author | Amir A. Ghaferi, M.D., M.S.

Despite the prevalence of obesity in the United States, the optimal approach to treatment remains unclear.

The traditional approach of diet and exercise, for example, is unsuccessful for the vast majority of patients. Obesity in general remains difficult to treat because of the overlap in genetic and environmental causes, such as the proliferation of fast food, increasing portion sizes and food additives.

Although there is growing evidence for genetic and hormonal factors as underlying causes, patients continue to be wrongfully blamed for their obesity, further contributing to an obesity bias in our society.

Major medical organizations now consider obesity a chronic disease. But effective management of obese patients remains poor, and the use of proven treatments such as bariatric surgery is low: Less than 1 percent of morbidly obese patients in the United States undergo bariatric surgery.

This bariatric surgery implementation rate is far lower than those of proven treatments in fields such as cardiovascular disease and cancer. Unfortunately, there are several barriers to wider adoption of bariatric surgery, including provider and patient concerns, misinformation, societal and cultural objections, and lack of insurance.

In our next #obsm Twitter obesity chat, we will focus on that last barrier: insurance coverage.

Legally, obesity is considered a disability, and patients may not be discriminated against in employment for being obese. Despite this law, whether insurance companies must cover obesity care continues to be debated.
The OBSM Group

'A barrier to care'

Insurers widely cover evidence-based treatment of other chronic diseases such as diabetes, cardiovascular problems and cancer. It is unclear why many private insurance plans do not cover bariatric surgery, or why the many that do place difficult requirements on patients prior to approval.

Patients with insurance plans covering bariatric surgery face increasingly longer wait times, which include mandated monthly nutrition visits. Initially, these visits were required for one month, but over time this waiting period has lengthened to 12 months on some plans. This is unusual and often functions as a barrier to care. For other types of surgery, requirements of patients prior to the procedure are left to the discretion of the surgeon and the needs of the patient.

In Connecticut, for example, approximately 66 percent of private health plans do not cover bariatric surgery. Legally, obesity is considered a disability, and patients may not be discriminated against in employment for being obese. Despite this law, whether insurance companies must cover obesity care continues to be debated.

Many patients with both type 2 diabetes and obesity do not have access to bariatric surgery despite overwhelming medical evidence supporting surgery as the most effective treatment for both conditions. Unfortunately, this leaves patients with obesity and related endocrine disorders to advocate for themselves and seek assistance from the political community to try to obtain coverage for medical and surgical treatments.

In our next Twitter chat, we look forward to engaging with patients, health practitioners, policymakers and other stakeholders to discuss the evidence around insurance companies' current policies, bariatric surgery for the treatment of obesity and diabetes, and how we can help patients with obesity to access the care they need.

The #obsm tweet chat, hosted by @obsmchat, will be held Sunday, Feb. 12, from 9 to 10 p.m. EST. We hope you can join us!

Amir A. Ghaferi, M.D., M.S. (@AmirGhaferi)

Neil Floch, M.D. (@NeilFlochMD)

Arghavan Salles, M.D. (@Arghavan_Salles)

Heather Logghe, M.D. (@LoggheMD)

Babak Moeinolmolki, M.D., (@DrBabakMoein

Tweet chat prompts

T1: Is obesity a disease?

T2: Are mandatory "medically supervised #weightloss periods" prior to #bariatricsurgery evidence-based?

T3: Does medical evidence support insurance coverage for #bariatricsurgery as a treatment to cure disease and improve patients' health?

T4: Independent of its impact on obesity, should #bariatricsurgery be a covered treatment for type 2 diabetes?

T5: How can patients and providers advocate for coverage of #bariatricsurgery, and what are the barriers?

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'A barrier to care'

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