Obesity and health care: Prevention and support, not penalties

Singling out obese individuals for higher insurance premiums based only on their weight is fundamentally unfair and will do little to improve the nation’s health. A more productive approach would be to require insurance companies to provide at least minimal coverage for obesity treatment.

Charging higher insurance premiums for obese people is based in part on the idea that weight is under voluntary control. Years of research shows that this is incorrect. Genetics plays an important role in determining weight. Some people have a genetic tendency for thinness; others for obesity. We do not increase insurance rates on women who have a genetic predisposition to breast cancer, so why should we penalize someone for a genetic predisposition to obesity?

Second, while it is possible to lose weight through changes in diet and exercise, research shows that most people are only able to lose 5 to 10 percent of their weight by these means. This amount of weight loss provides health benefits but is usually not enough to become “normal weight.”

Thus, a person who makes healthy choices and is doing everything he can to take control of his health would still be penalized. For example, a 5-foot-6 woman who weighs 220 pounds would need to lose 65 pounds with diet and exercise alone to achieve a “normal weight.” She would then need to maintain this degree of weight loss for the rest of her life. This is unlikely to happen.

Recent studies have shown that there is a strong biological tendency toward regaining weight after a large weight loss. In fact, normalizing weight is not required for health benefits. It is more productive to focus on promoting healthy behaviors rather than forcing individuals to aim for a weight goal that might be unrealistic.

Charging higher insurance premiums for obese people is also based on data showing that these people generate higher health care costs. While true on average, research has shown that many obese persons are “metabolically healthy” with normal blood sugar, blood pressure and cholesterol levels. These individuals are not at greater health risks, and it is unfair to charge them more.

In addition, studies have shown that obese people who are physically fit have the same risk of dying from heart disease as do normal weight people who do not exercise. It is unfair to penalize the obese person who is taking responsibility for his health and not penalizing the normal-weight, sedentary individual who is not. Type 2 diabetes, high blood pressure and high cholesterol levels are the product of many of the same lifestyle habits that promote obesity. What about these other “lifestyle diseases”? Should we charge more to people with high blood pressure because they’re eating too much salt?

It is easy to see how this logic can get out of control. If we want to penalize a group that is not taking responsibility for their health, it makes more sense to target people who do not regularly take their blood pressure and cholesterol medicines to prevent heart attacks and strokes. Taking one’s medicines as prescribed is much easier than losing a large amount of weight and keeping that weight off.

Most employers do not provide comprehensive insurance coverage to treat obesity. Treatment for hypertension, diabetes and high cholesterol are covered, but employers and insurance plans do not usually pay for structured weight loss programs, medically supervised diet plans, or weight loss medications. Bariatric surgery is sometimes covered, but only after patients jump through many hoops to receive it.

The situation may be changing, however. The Affordable Care Act (ACA) allows employers to offer a 30 percent discount on insurance premiums for wellness programs like smoking cessation, weight loss, medication adherence, and others. The ACA is clear that employers should incentivize individuals for healthy behaviors per se, not for the outcomes of those behaviors. Some employers and insurance plans have recognized the importance of addressing the obesity epidemic using by providing at least some support for treatment.

The health plan at the Anschutz Medical Campus now pays a portion of the cost of a group weight loss program for employees. Providing support for treatment will move us closer to a solution to this problem than will penalizing people for their weight.

No one chooses to be obese. Obese people want help losing weight.

Finally, charging higher insurance rates for obese individuals has the potential to worsen disparities in health for groups with higher rates of obesity. For example, people with lower incomes have less money to purchase healthy food, and less time for recreational exercise. Thus, they are less likely to be able to perform the behaviors that would result in weight loss. Charging poor people more for health insurance does not seem like a sensible way to improve health.

We all need to take responsibility for our health by eating well, exercising, and getting recommended preventive care and health screenings. A financial penalty for being obese or an unrealistic weight loss goal will not produce behavior change. Providing insurance coverage for obesity as we do for other health problems is a better approach.

Adam Gilden Tsai is an internal medicine physician and obesity specialist with the Anschutz Health and Wellness Center at the University of Colorado. Daniel Bessesen is the chief of endocrinology at Denver Health Medical Center and an associate director of the Anschutz Health and Wellness Center.
Read more: Obesity and health care: Prevention and support, not penalties – The Denver Post http://www.denverpost.com/opinion/ci_20754953/obesity-and-health-care-prevention-and-support-not#ixzz1wqysHSRy
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