Coverage of Obesity Treatments

Pharmaceutical and surgical interventions can treat obesity.

In MO, roughly 1/3 of adults and 1/6 of children are obese, with the main drivers being poor diet and lack of physical activity (CDC 2021).

Behavioral and dietary changes are the primary methods for prevention of weight-gain and weight-loss. Since 2013, several medical soci-eties have recommended pharmaceutical and surgical interventions for body mass indices (BMI) higher than 30 (obese) that do not achieve at least 5% weight loss after 6 months (Sombra 2022; Cornier 2022).

• BMI measures normal body weight for height ranges, but it is not the best diagnostic for unhealthy levels of body fat (CDC 2022).

Pharmaceutical

The Food and Drug Administration (FDA) has approved 6 weight loss medications. Table 1 lists the drugs/type, intended patient populations, efficacy of at least 5% weight loss after 1 year (Idrees 2022; Mayo Clinic 2022; Haqq 2022).

• The oldest drugs came to market in 2010, so data on side effects and efficacy 3-5 years after treatment is limited (Nordmo 2020).

Nutritional Counseling

Nutritional counseling includes behavioral therapy and lifestyle plan-ning with registered dieticians to achieve weight loss or management.

• This form of counseling can be up to 72% effective (Bleich 2014).

Surgery

Obese individuals who have not achieved 5% weight loss within 6 months are candidates for surgical intervention.

• Intragastric balloons are saline-filled devices inserted into the stomach for a period of 6 months; this procedure is often not effective.
• Bariatric surgery physically reduces the size of the stomach, either through a tightening device or surgical reduction. Procedures can be up to 72% effective at long-term (2 years post-surgery) weight loss maintenance (Ruban 2019).

Liposuction removes and contours small amounts of under-the-skin fat, and is neither an overall weight-loss treatment nor covered by insurance (Mayo Clinic 2021).

More states cover obesity treatments through Medicaid than private insurance.

Only screening and behavioral counseling for obese patients must be covered under the Affordable Care Act (CMS n.d.).

As of 2022, 18 states covered pharmaceuticals, 48 states covered bariatric surgeries, and 26 states covered nutritional counseling through Medicaid (Figure 1).

• 2 states require private coverage of drug therapies, 20 require private bariatric surgery coverage, and 38 require coverage of dietary counseling (Urban Institute 2022).

As of 2021, fewer than 2% of obese patients in the U.S. had been treated with an anti-obesity drug due to strong side effects, low prescription rates, low insurance coverage, and/or need for prior behavioral changes (Nordmo 2020).

Treating obesity results in cost savings & health improvements.

Costs

Individuals with a BMI over 40 who lose at least 5% of their body weight can save medical and insurance costs by over $2,000 per year (Cawley 2014).

• One study estimated that, should all eligible individuals with a BMI over 35 have access to obesity medications, the Medicare/ Medicaid system would save $231 and $188 billion, respectively, over 75 years (Kabiri 2021).
• The U.S. government could recoup $452 billion in taxes from individuals out of the workforce due to obesity (Kabiri 2021).

Treatments that lead to a 5-10% weight loss are associated with lower out-of-pocket costs for individuals of other pharmaceuticals, including:

• insulin ($122/mo.),
• diabetes pills ($42/mo.),
• high cholesterol ($61/mo.), and
• hypertension ($0.20/mo.; Greenway 1999).

Health

Post-obesity weight loss is associated with lower rates of cancer, depression, heart disease, and blood sugar spikes (Aronne 2001; Sampsel 2007).