Does Insurance Cover Weight Loss Treatment?
As with many things in life: it depends.
But the good news is… this is changing! It’s changing quicklyit’s changing for the better. Let’s talk about what is changing about this industry,why it could have a huge impact on your life.
Have insurance companies always covered weight loss programs And i just didn’t know about it?
No, traditionally, weight loss treatment has not been covered by insurance.
This has been due to many reasons, such as stigma towards obese individuals, lack of options,most commonly a lack of desire by insurance companies to cover this type of treatment. But thankfully, many insurance companies are coming around to the idea of covering obesityweight loss treatment. But why are insurance companies all of a sudden changing their mind about this? There are multiple reasons for this change.
Table of Contents
De-Stigmatization of Obesity
In the past,unfortunately sometimes still today, obesity has been seen as a behavioral problem rather than a medical condition. Only very recently has obesity been referred to as a medical condition, even within the medical community. Obese individuals have simply been given the blame for their weight, due to their own personal decisions, with no further explanation or solution given to them. The stigmatization of obese individuals does nothing to address the causes of obesity, weight gain,weight loss struggles, rather it has further generated health disparitieshindered efforts to combat this issue. In order to better understand obesity to develop safeeffective treatments, we must first accept that it is a medical conditionnot as simple as having a “lack of self-control.” Fortunately, the medical communitysociety seem to have taken that first step towards accepting this,seem ready to find solutions.
Affordable Care Act
In 2010, The Affordable Care Act was signed. This act includes several provisions that aim to promote preventative care, which includes obesity screeningtreatment. According to an article written by the National Academy of Sciences, “The Patient ProtectionAffordable Care Act (ACA) contains a mandate for coverage of obesity treatment, corresponding to the recommendations of the U.S. Preventive Services Task Force for screening of all adultschildren aged 6older for obesity.” (1) There is not an exact definition as to what this obesity treatment must look like, so this treatment may vary depending on the insurance policystate that one resides.
Weight Loss TreatmentPrograms
Due to this change in legislature, there has been a rise in options for weight loss treatment in the medical field. Now that healthcare providers are able to provide these services through insurance, a whole new world of weight loss options is available to patients seeking help. This is amazing news for those who have struggled to lose weight on their ownwho seek affordable options covered by their health insurance.
Weight loss treatment covered by insurance can be found in various settings with various types of healthcare providers:
- Primary care providers
- Board-certified Obesity Medicine Doctors
- Nurse Practitioners
- Certified Health Coaches
- Nutritional Counselor/Therapist
Coverage varies from plan to plan,may look different depending on the state. One of the treatment plans that is covered by most insurance policiesgaining traction in the last couple of years is a medically assisted weight loss program.
What is a Medically Assisted Weight Loss Program?
Patients in a medically assisted weight loss program are given the support of a healthcare providerhealth coach, along with a customized meal plan, exercise routine, habit-forming tools,when the physician sees it necessary, prescribed medicationssupervision. This is a safe, effective,affordable way to access weight loss treatment.
Who Qualifies For A Medically Assisted Weight Loss Program?
- Individuals with a BMI of over 30 (obese)
- Individuals with a BMI of over 25 (overweight) with comorbidities
Providers will also provide referrals to bariatric psychologists, dietitiansother medical professionals if needed to help support successful weight loss.
Insurance Companies And Employers Will Ultimately Save Money
In 2020, the prevalence of obesity in the United States reached 41.9%. Severe or morbid obesity reached 9.2%. Obesity-related conditions can include heart disease, high cholesterol, high blood pressure, stroke, type 2 diabetescertain types of cancer. In 2019, the estimated medical cost of obesity in the United States was $173 billion. The CDC stated that on average, medical costs for adults who had obesity were $1,861 higher per year than medical costs for people with healthy weight. (2)
Obesity is far more complex than simply needing to lose weight. Obesity can have a detrimental effect on one’s physicalmental health. Having a large quantity of excess weight has an impact on the hormonessystems of the body,an imbalance of these hormonessystems can lead to more serious health conditions.
It is extremely important to address preventative care,not only address conditions once they have fully developed. Most people have heard the term “pre-diabetes” or being “pre-diabetic.” This condition should not be taken lightly. When one is considered pre-diabetic, this means that their blood sugar levels are higher than normal, but not high enough yet to be diagnosed as type 2 diabetes.
There are approximately 96 million American adults, 1 in 3, who are considered to be pre-diabetic. (3)The scariest part is that of those with prediabetes, more than 80% don’t know they have it. The reassuring part is that you as an individual can do a lot to prevent the onset of type 2 diabetes if you are in this position. You may be able to prevent or delay diabetes by losing just 5-7% of your starting weight. For instance, if you weigh 200 pounds, your goal would be to lose about 10 to 14 pounds. Losing only 5-7% of your current weight can have a huge impact on lowering your risk for developing diabetes. This is why preventative care is so important.
Ultimately, this is why insurance companies have suddenly gained interest in programs such as these. The goal of an insurance company is to keep costs low. This means, the healthier the patient, the lower the costs. Many of these companies have finally come to realize that preventative care is the best way to keep medical costs down, as they are able to prevent or reduce the risk of developing these obesity-related conditions. This comes as a win-win for both the insuredthe insurer.
What Is The Takeaway?
Start taking advantage of these treatment options covered by insurance today. Do not wait to take control of your health. Finally, there are some affordable options that may help you achieve the quality of life that you have been searching so long for. Find a medically assisted weight loss program near you or through telemedicine.
National Academies of Sciences, Engineering,Medicine; HealthMedicine Division; FoodNutrition Board; Roundtable on Obesity Solutions. The Challenge of Treating ObesityOverweight: Proceedings of a Workshop. Washington (DC): National Academies Press (US); 2017 Dec 21. 8, Payment Considerations. Available from: https://www.ncbi.nlm.nih.gov/books/NBK475871/
Centers for Disease ControlPrevention. (2022, May 17). Adult obesity facts. Centers for Disease ControlPrevention. Retrieved September 2, 2022, from https://www.cdc.gov/obesity/data/adult.html
“Prediabetes – Your Chance to Prevent Type 2 Diabetes.” Centers for Disease ControlPrevention, Centers for Disease ControlPrevention, 21 Dec. 2021, https://www.cdc.gov/diabetes/basics/prediabetes.html#:~:text=Prediabetes%20is%20a%20serious%20health,t%20know%20they%20have%20it.