What is the true cost of obesity?

Jennifer Nelson

A staggering sixty-six million Americans over 40 are obese, according to a report on the Health Status of the 40+ Population, from the MetLife Mature Market Institute and co-authored by the Center for Healthy Aging.

And people who are obese can also suffer from serious obesity-related health conditions. For example, the study found that 9 percent of obese people have Type 2 diabetes and 31 percent have high blood pressure.

Obesity complications also can include:

• Some cancers such as colon, breast and pancreatic.
• Heart disease.
• Risk of stroke.
• Disability.
• Back and knee problems.

In 2013, the American Medical Association voted to officially recognize obesity as a disease, rather than a condition. This may change the way doctors treat the problem, and how health insurers cover it. Medical conditions such as heart disease are covered health benefits but if the patient is obese, the heart disease may be classified as a preexisting condition. Until 2014, when the Affordable Care Act fully kicks in, people with preexisting conditions may still be denied health insurance coverage.

Obesity can also cost people more in the workplace. A Mayo Clinic report, “The Cost of Health” found that not only do obese workers cost their employers more each month in regards to their health insurance benefits, but their productivity levels at the office were found to be lower than their normal weight colleagues.

How health insurers cover obesity

Health insurance applications require you to disclose your height and weight. If you’re overweight or obese, insurers may deny you coverage or charge you a surcharge based on your weight, says Larry Cossio, owner of Cossio Insurance Agency in Simpsonville, S.C.

This surcharge depends on the severity of the obesity-related condition. “If you have a heart problem, you might pay 200 to 300 percent more (than the standard rate), depending on (your) age,” Cossio says.

Most private insurers, employers and state health plans typically exclude weight loss surgery from their coverage policies. However, some will cover certain procedures such as gastric bypass surgery (which costs $25,000 to $35,000) or lap band surgery (which costs $17,000 to $25,000) under certain circumstances, but will typically only cover up to $15,000 of the bill, leaving the patient to pay the rest out of pocket.

And even if your insurer will cover weight-loss surgery, it can be very difficult to qualify for the procedure. Insurers set strict requirements for how many pounds overweight you must be, how many diet plans and other weight loss methods you’ve attempted previously. Also, prospective patients must go through a thorough psychological evaluation in order to qualify for a weight loss procedure.

“Most folks…can’t make it through the rigorous requirements to qualify,” says Oliver Fischlewitz, vice president of Ability Risk Management, a full service insurance agency in Oak Lawn, Ill.

Of his clients who’ve gone through the process, only 30 percent got approved, Fischlewitz says.

How Obamacare will change how insurers treat obesity

The health community believes the insurance industry will catch up with the demand for coverage of weight loss surgery, says Dr. Scott Cunneen, director of bariatric surgery at Cedars-Sinai Medical Center and author of “Weight Issues: Getting the Skinny on Weight Loss Surgery.”

Hopefully, having weight loss procedures covered by insurance will help prevent or reverse the diseases associated with obesity, like diabetes, hypertension and heart disease and save everyone money, Cunneen says.

Back in the 1990s and early 2000s health insurers added dietitian consultations, nutrition and weight control programs and other preventive weight-related services to health insurance policy coverage. Some health industry experts think weight loss surgeries will eventually become covered procedures as well.

The biggest change with Obamacare will be that people who are obese and previously denied coverage or charged an enormous surcharge will be able to obtain reasonably priced health insurance. “With Obamacare, you can’t be denied for obesity or excluded for obesity-related preexisting conditions,” Cossio says.

“My guess is height and weight won’t even be a question anymore on a health insurance application,” Fischlewitz says.