The American Medical Association recently designated obesity as a disease, a move that could impact what treatment options are covered by employer-sponsored health plans.

Because health insurers often use guidance from physician groups like the AMA to determine which treatments are appropriate and should qualify for coverage, obesity’s disease designation will likely expand coverage to some of its treatment options.

In addition, the change could cause more doctors to start actively treating obesity, rather than leaving it mostly unaddressed.

Employers that aren’t covering obesity treatments already may need to start doing so, according to Sadhna Paralkar, M.D., an independent health management consultant. This will mean additional costs to employers as more treatments get covered.

“This investment has huge potential to pay off in the long run and is beneficial to both employers and employees,” she adds. “Benefit consultants and brokers should be aware of the change and help shape how the treatments are presented and monitored.”

Treatment options for obesity include prescription medication, bariatric surgery, and counseling programs on nutrition and exercise. Many employers offer wellness programs and incentives to encourage their workers to exercise more often and maintain a healthy diet.

“With the addition of new prescription drug therapies, patient monitoring and coaching services and less invasive surgical procedures available to patients, exciting new step-therapy programs offer new cost-containment strategies for health plan sponsors,” says Paralkar. “Any effort to change patient behavior is worthwhile because the long term health benefits and the associated savings can be substantial.”

As employers and benefits advisers, alike, know, obesity increases a person’s risk for diabetes, hypertension, heart disease, cancer, stroke, sleep apnea and osteoarthritis, according to the U.S. Centers for Disease Control and Prevention (CDC). These diseases can all lead higher insurance premiums.

Previously, coverage of obesity treatments was “spotty and inconsistent,” says Paralkar. “Brokers probably had to read through many plan documents to decide which plans covered obesity-related treatment and which did not in order to answer questions from their clients.”

Benefit advisers should take an active role in creating the right plan language that meets the needs of plan sponsors and plan participants, she adds.

What will it mean for employers and health plans if obesity treatments are regularly covered in the future?

Paralkar predicts, “As the costs associated with treating obesity increase, more attention will be paid to best pricing and competitive pricing, leading to downward pressure on the procedures and drugs that treat obesity.”

More than 36% of U.S. adults are obese, according to the CDC.                  

Register or login for access to this item and much more

All Employee Benefit Adviser content is archived after seven days.

Community members receive:
  • All recent and archived articles
  • Conference offers and updates
  • A full menu of enewsletter options
  • Web seminars, white papers, ebooks

Don't have an account? Register for Free Unlimited Access