Getting Paid for Treating Obesity, Now That It's a 'Disease'

Leigh Page


July 17, 2013

In This Article

When the American Medical Association (AMA) recently named obesity a disease, it was a sign of growing concern about weight problems. More than one third of adults and almost one fifth of children and teens are obese.[1]

Because doctors are able to get paid by insurers for treating disease, does this mean that now that obesity is considered a disease, physicians can get paid specifically for treating it?

Proponents hope the AMA's taxonomic upgrade will nudge payers to take obesity more seriously and improve coverage -- which has been notoriously hard to get for weight-loss therapies, such as behavioral counseling, drugs, and surgery. Significant improvements in insurance coverage, however, could take years.

In the meantime, physicians will have to make do with a few incremental changes under Medicare and the Affordable Care Act (ACA). Meanwhile, they can start taking advantage of new payment methods that favor treating obesity as a root cause of diabetes, heart disease, and sleep apnea.

The June 18, 2013, vote by the AMA House of Delegates that named obesity as a disease was a grassroots rebellion. However, many physicians disagreed with the new classification. The AMA's Council on Science and Public Health released an extensive report coming out against the change[2] and citing the need for more research.

The 457 voting delegates, representing state and specialty medical societies, overruled the council by a vote of approximately 60% to 40%. They approved a resolution classifying obesity as "a disease state with multiple pathophysiological aspects requiring a range of interventions."[3]

What Does This Mean for Payment?

Samuel Klein, MD, director of the Center for Human Nutrition at Washington University School of Medicine in St. Louis, applauds the AMA action. Although it merely "changes labels," Dr. Klein said, "labels are very important. The label determines how obesity is managed and whether third-party payers cover it."

Walter Lindstrom, an attorney and president and CEO of Lindstrom Obesity Advocacy in Chula Vista, California, which helps obese people get coverage for weight-loss surgery, sees a trend toward better access to obesity treatments, but he said it will take a while.

The AMA decision was widely reported, and Lindstrom immediately began getting calls from obese clients and physicians who treat obesity, asking whether insurers had changed their policies yet to comply with the AMA action. They assumed that once a condition gets official disease status, payers would have to cover it. Lindstrom had to explain that nothing had changed, because the AMA has no authority over insurers.

The AMA action at least got insurers' attention. At Blue Cross Blue Shield of Illinois, Medical Director Elif Oker, MD, said the company is studying the action. "We are taking it seriously, as we would any other statement from any other clinical group," she said. "We take a look at all of what is out there."


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