Insurance coverage of obesity, lack of formal diagnosis emerge as top barriers to getting professional weight loss help

"These two barriers to care -- no insurance for medical weight loss support and lack of initial diagnosis -- can negatively impact people with obesity or overweight as they seek support from those most adept, trained weight-loss professionals," said Scott Kahan, MD, MPH spokesperson for The Obesity Society (TOS) and director at the National Center for Weight and Wellness. "While self-management strategies, such as following a commercial diet or increasing exercise, can help in some individuals, most people with obesity, especially those with severe obesity, can benefit from a comprehensive approach that includes healthcare professional support."

Research results from these two studies will be shared today at The Obesity Society Annual meeting at ObesityWeek℠ in New Orleans, Louisiana. Ruchi Doshi, MPH at the Johns Hopkins University School of Medicine and the Johns Hopkins Bloomberg School of Public Health will provide an oral presentation on her health insurance coverage survey, and Bartolome Burguera, MD, PhD, of Cleveland Clinic's Endocrinology and Bariatric Institutes and Director of Obesity Programs at Cleveland Clinic will present a poster regarding study findings on the initial diagnosis of obesity.

"More than half, 57%, of the 450 health professionals we surveyed believe that improved health insurance coverage for weight loss is a solution to greater access to care, and this finding cuts across all patient income levels," said Ms. Doshi. "Furthermore, we found that a quarter of health professionals perceive current insurance coverage to be a weight-loss challenge."

The most recent treatment guidelines for obesity strongly recommend counseling by health professionals to help people with diet, physical activity and changing behavior, yet few people have access to these services. Studies of physicians have previously documented lack of reimbursement as a barrier to providing weight loss services, and now this first-of-its-kind survey adds the input of non-physician health providers engaged in weight-loss services.

In the second study, funded by Novo Nordisk, Dr. Burguera and his colleagues reviewed nearly 325,000 electronic health records from the Cleveland Clinic to see if patients with obesity or overweight as identified via BMI received a formal diagnosis using ICD-9 documentation. This cross-sectional summary from a large U.S. integrated health system found that of all patients with a BMI > 30, only 48% had documentation of an ICD-9 code for obesity. In those patients with a BMI > 40 (considered severe obesity), only 75 percent had an ICD-9 code for obesity.

"The disease of obesity is very prevalent yet too often underdiagnosed, which could be an important barrier to getting initial care," said Dr. Burguera. "By providing a formal diagnosis, we may be able to help people get the treatment they need to lose weight and get healthy."

It's unclear why doctors aren't providing a formal diagnosis for obesity. However, Dr. Kahan says, "This could go hand-in-hand with coverage: if doctors aren't being paid to treat obesity, they may not see any benefit in making a formal diagnosis. Regardless, there is a clear need to advance the understanding of medical diagnosis and treatment of obesity across the spectrum, from providers to policymakers."

In an effort to increase that understanding, TOS has joined with nearly 30 of its partners to help advocate for a change in the way obesity is treated in the medical setting. This week, during the second annual National Obesity Care Week, Oct. 30 -- Nov. 6, campaign partners are asking physicians and other care providers to "Take 5" -- that's five minutes to have a productive conversation with patients about their weight.