The government will finally cover obesity care for its employees — but not the rest of us

Obesity is a complicated disease that is poorly understood by the public. Unfortunately, treatment for this disease is hindered by societal misconceptions and discriminatory beliefs that confuse appearance with disease. The recent media coverage and popularity of new anti-obesity medications (AOM) has given some more confidence to seek treatment for this disease. However, most people still cannot access care because their insurance will not pay for it — unless you are a federal employee.

That’s right, beginning this year, all health plans that serve federal employees must provide coverage for AOMs. In rolling out this new guidance, the feds are quite clear — emphasizing that “obesity has long been recognized as a disease in the U.S. that impacts children and adults” and that “obesity is a complex, multifactorial, common, serious, relapsing, and costly chronic disease that serves as a major risk factor for developing conditions such as heart disease, stroke, type 2 diabetes, renal disease, non-alcoholic steatohepatitis, and certain types of cancer.”

While this is great news for more than 8 million federal employees, retirees and their families, it still leaves out millions of other Americans who could benefit from access to comprehensive obesity care — particularly those being served by government plans offered under the Affordable Care Act (commonly called ObamaCare) and Medicare. For example, many state health exchange plans governed by ObamaCare currently exclude coverage for any treatment related to obesity or weight loss — even if these treatments would help an obesity-related medical condition. Medicare — our country’s federal health insurance program for seniors — continues to exclude coverage for AOMs based on regulations passed more than 30 years ago.

For generations and still today, obesity has been thought of as a lifestyle choice that can be fully regulated by diet and exercise. While diet and exercise can help you lose weight, they are ineffective at maintaining weight loss for most people. These lifestyle interventions are more successful when they are accompanied by intensive behavioral counseling, medication and/or surgery. The most concerning thing about obesity has nothing to do with your appearance, but instead how it impacts your health. Obesity and related conditions are the second leading cause of preventable death. Around 70 percent of Americans are affected by this disease in some way. 

Obesity medicine specialists are more prepared than ever to treat this disease. For example, the recent release of the anti-obesity medications Wegovy to the market has changed the game. It works by enhancing a hunger related hormone to decrease hunger and increase fullness. Studies indicate that more than 85 percent of participants who took this medication lost weight and kept it off. Surgical intervention, such as metabolic and bariatric surgery, has been the gold standard for treating those with severe obesity. New scientific guidelines recently announced that expand indications for surgery so that more people can be helped earlier in their disease. In short, health care professionals now have a full toolbox of options to treat obesity.

I applaud the federal government for taking care of their own employees and offering obesity care coverage — but I question why so many other Americans served by other federal programs are being left to fend for themselves. Congress must act this year to eliminate Medicare’s three-decade-old discriminatory prohibition on covering AOMs by reintroducing and passing legislation such as the Treat and Reduce Obesity Act (TROA), which will allow coverage for obesity drugs and allow more health care professionals to provide intensive behavioral therapy for obesity. Congress should also work with the White House to modernize federal guidance governing ObamaCare health plans to ensure that obesity is recognized as a chronic disease — worthy of coverage for comprehensive treatment avenues as an essential health benefit.

Over 9 percent of the U.S. gross domestic product was spent treating the consequences of obesity. Around 500,000 people are dying annually in the U.S. for reasons that were ultimately caused by obesity.

It is time to let go of the myth that diet, exercise and willpower alone are going to solve this health crisis. It is time for all public and private health plans to follow the lead of the federal employee’s health plan and standardize access to care to obesity treatments.

Shauna Levy (MD, MS, FACS, FASMBS, Diplomate of the American Board of Obesity Medicine) is an assistant professor at Tulane University, obesity medicine specialist, bariatric surgeon and medical director of the Tulane Bariatric and Weight Loss Center. Levy is the State Access to Care representative (STAR) for Louisiana in the American Society of Metabolic and Bariatric Surgeons. Follow Levy on Twitter: @Smlevy82