In 2004, the Centers for Medicare and Medicaid Services (CMS) removed language claiming that obesity was not a disease from its official manual and guidelines. Public health advocates interpreted that as a tacit endorsement of treating obesity like a disease, and hoped that would lead to more research into effective obesity-fighting tools and encourage states and insurers to fund benefits through Medicaid and private insurance. But a comprehensive 2010 analysis of public and private insurance programs’ policies towards obesity concluded that “most states are not ensuring recommended screening and treatment of adults and children for obesity through Medicaid, the [Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program for Medicaid-eligible children], or private insurance.”
There are currently three main coverage categories for treating obesity: nutritional consultation, drug therapy, and bariatric surgery. According to the journal Public Health Reports, only eight states’ Medicaid programs cover all three categories, and 20 states’ programs explicitly exclude nutritional consultation for obesity. The most commonly covered category is bariatric surgery, which is far more expensive and invasive than preventative nutritional counseling or drug therapy — which is the least-covered category — would be. In the private insurance market, the report found that “few states have passed legislation requiring coverage of obesity treatments” and that some even explicitly exclude covering it as a disease.
Without comprehensive coverage, individuals end up having to pay to separately manage each of chronic conditions that stem from obesity, such as diabetes, hypertension, and heart disease. That’s not just cumbersome and expensive for Americans, whose obesity rates are at epidemic levels — it’s costly for health entitlement programs, too. Obesity-related illness makes up anywhere from 10 to 12 percent of all health insurance spending, including 11 percent of Medicaid expenditures.
That’s why proponents of the new AMA resolution argue that officially labeling obesity a “disease” could spur change and “result in greater investment by government and the private sector to develop and reimburse obesity treatments.” Medicaid is a particularly important vehicle for giving Americans access to health coverage for obesity-related health problems, since the poor are far more likely to be obese than wealthier Americans who usually have private insurance through an employer.