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Life Health > Health Insurance > Health Insurance

Obesity: The not-so-new "disease"

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More than one-third of adults and approximately 12.5 million children in the United States are categorized as obese. The average American is 23 pounds heavier than the ideal body weight. Pound by pound, Americans have become heavier as processed and fast food, dormant lifestyles and gigantic portions have become the norm. In sad news, the Centers for Disease Control and Prevention estimates that 42 percent of U.S. adults will become obese by 2030, which will undoubtedly lead to higher levels of heart disease, diabetes and a laundry list of other high-cost and high-severity ailments. Essentially, obesity often leads to death in one way or another.

It’s not much of a surprise then, that the American Medical Association (AMA) classified obesity as a disease in June, suggesting that the new definition would bring more attention to the matter from physicians and, therefore, help in the fight against such diseases that it spawns.

Mark Ulrich, senior vice president at Poms & Associates Brokerage, a California-based insurance firm specializing in employee benefits and corporate wellness plans, sees this designation as a positive thing not only for consumers, but for insurance companies as well. 

“I think this is a good thing for consumers,” he says. “I think this is something that needs to be talked about in a doctor’s office. I think with the right, responsible doctor that it’s a good thing to help people get into better shape and to talk about things and perhaps, if needed, to prescribe different types of medications to help them. mark ulrich

“I mean, there are 70 million people [in the U.S.] that are 30 percent above average in terms of body mass index. And that’s just known. So imagine all the people that don’t go to the doctor, that don’t discuss weight, that maybe aren’t 30 percent, but are 20 percent above average. They are now going to have access to prescriptions, instead of buying over-the-counter weight control products out of their own pocket.“

Indeed, being able to openly discuss and treat obesity is a huge benefit to the millions of Americans struggling with weight control. But what about the insurance industry and employers? Will this designation have an impact? According to Ulrich, affects will be seen in several ways.

“First of all, doctors will now have the opportunity to treat obesity as any other disease,” he says. “The procedure will go from a conversation to actual treatment that will probably include a prescription.”

As we know, the over-the-counter weight loss supplement business is a billion dollar industry that will now get the company of prescribed medications. “If you are overweight, will you continue to pay for Weight Watchers — as an example — at your cost, or something akin to that prescribed by your physician through your insurance?” Ulrich asks.

He uses the following example: Say you have a company with 100 employees and those 100 employees have a track record during the year of illnesses and claims and a lot of that is attached to prescription drug usage. An insurance company will look at the activity of an account and will weigh the prescription drug usage heavily because they feel that is a component of potential chronic illness. When they start to see drug usage going up, they are going to attach different numbers to those facts and “double and triple” what they think the potential costs will be for the following year. And that’s going to significantly affect any employer.

“But for the employer that self-insures — the larger companies — their skin is in the game,” Ulrich says. “One of the reasons they self-insure is because they want the responsibility of the claims — certainly the small ones. So they’re always trying to do things to reduce that exposure. And now, with doctors being able to basically prescribe slim shakes or something like that, that dollar is now going to go to the employer, whereas before they had to buy it over the counter on their own. So that’s going to significantly affect the employer’s cost.”

But there are also risks involved with giving doctors the ability to prescribe weight loss aids. The news is constantly reporting on the increase in addiction to prescription narcotics and the issue of over-prescribing.

“From what I see, there are a lot of doctors that over-prescribe,” Ulrich says. “I think that this is going to be another opportunity to over-prescribe medications to people. That could be the negative. And I think that in [over-prescribing], that bill goes, ultimately, to the employer through the insurance company.”

obesity costsWith high costs to all parties involved (click to enlarge chart at right), it begs the question: Will this obesity classification really be worth it in the long run? Ulrich thinks so.

“Yes, optimistically yes, I do think it’s worth it,” he says. “Because now we can talk about it. Because now with the responsible doctors and with the people that really do want to get help, there’s something to talk about.

He compares it loosely to a few years ago when the AMA classified mental illness as a disease. That classification allowed those with mental illness to obtain treatment and have it paid for by the insurance companies.

“For those that do have mental disorders, in my humble opinion, I think we can look 10 years down the road and see that it did help these people who needed help and [they] deserved to have it classified as a disease because it is a disease,” Ulrich says. “It’s not something they created on their own. There’s a chemical issue going on and it should be treated with the same sensitivity that cancer or something similar would be.”

Obesity is not as cut and dry as mental health disorders, however, as Ulrich states. The line is not so clear but the point is that, in the long run, this move by the AMA will not only help those who are overweight and therefore prone to other diseases, it will also help the insurance companies.

“If I was a large insurance company, I would be happy about the new business that will come through obesity,” Ulrich says. “The insurance company will adjust to increased doctor visits and prescription claims by increasing the cost of insurance and if, as I hope, this decision makes people healthier, then the insurance company will pay less for large claims caused by obesity without reducing the cost of insurance for a healthier population. It’s a win either way.”

Though some argue that, in the short-term, the obesity classification by the AMA will result in higher insurance costs for consumers, it’s hard to argue that, as Ulrich points out, this is not a good thing in the long run for all involved. Years from now, as we, hopefully, become a healthier nation, we will rely less on prescribed weight control medications and learn how to live a naturally healthy life. And maybe, just maybe, move away from the top five ranking of most overweight nations. Thanks to the AMA, there is hope.   

See also:

Dubai diet: Slim down, get paid in gold

Fatists won’t cure obesity epidemic

America’s mental health care crisis: A story in numbers


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