AMA’s Obesity Declaration Could Open Door for Coverage, Treatment | Page 2
Published Online: September 27, 2013
What drives coverage decisions is far from clear to Ethan Lazarus, MD, director of Clinical Nutrition Center, an obesity medicine practice in Denver, Colorado, that performs bariatric surgery. “Unti now insurance companies could sit by and say this (obesity) is not a disease and not pay for treatment, even though people are dying from this disease at an alarming rate,’’ said Lazarus, who spoke in favor of the policy during the AMA debate as delegate from the American Society of Bariatric Physicians.
Lazarus cited the case of a recent new patient, an obese a 39-year old father of 2 young children. He was suffering congestive heart failure, type 2 diabetes mellitus, sleep apnea, depression, and psoriasis. The man’s cardiologist advised bariatric surgery, but his insurance company would not pay for surgery and stopped him from paying for it, according to the patient.
“I was told that if I paid for the surgery myself that I would not be covered medically for any complications that may arise from the surgery for (my) lifetime,’’ the patient, who asked for anonymity, wrote in an e-mail. “Given my diabetes and CHF I am at a higher risk for complications and the fact that they said for lifetime, who knows what they would blame on the after effects of the surgery and deny me coverage.’’
Lazarus said he’s hopeful the AMA recognition of obesity as a disease will eventually lead to a standard criteria for health insurance to cover surgery but also systemic changes. “This resolution is saying we should treat the obesity as we do the high blood pressure,’’ he said. “There needs to be coverage and medical school education. I am a board-certified physician and I got 4 lectures on nutrition and none on obesity in medical school.’’
Shortly after the vote, the AMA view of obesity as a disease had legal significance. An employee of Car-Mart Inc in Missouri filed suit in federal court claiming he’d been fired for being “severely obese’’ in violation of the American with Disabilities Act (ADA), the first time obesity has been cited in an ADA suit.12 Jon Hyman, a Cleveland employment law attorney with Kohrman Jackson & Krantz specializing in the American with Disabilities Act, said the prestige of the AMA will inevitably makes its view on obesity a factor in disability claims. “That is the trade association of physicians, and when they speak or offer an opinion, people tend to listen,’’ he said.
LuAnn Heinen, vice president at the National Business Group on Health, based in Washington, DC, said employers shouldering the costs of health insurance have long been focused on obesity. “By itself the AMA action doesn’t mean that much for employers because they have been concerned about the issue for a long time,’’ Heinen said. “It improves the ability to analyze claims data because obesity is now coded. We are worried it might be used to drive more use of medical services when the message we need is to change our lifestyle and choices. Bariatric surgery is a covered benefit, but everybody would prefer it wasn’t needed, which is why many companies use Weight Watchers, online coaching, various incentives and benefits.’’
Many observers view the AMA’s obesity declaration as momentous, similar to its 1956 recognition of alcoholism as a disease or the Surgeon General’s warning on cigarettes in 1964. Neither action had immediate consequence or was binding on anyone. But both events proved to be turning points, after which there was a gradual shift in thinking: Instead of the conditions being viewed as the actions of individuals with health consequence, they were recognized as matters of treatment and public health.
“This (designation of obesity as a disease) is not on our radar screen among current issues but we’re aware of it,’’ said Jason Hammersla, director of communications for the American Benefits Council. He noted employers and insurers evolved substance abuse and mental health benefit packages for decades before the Mental Health Parity and Addiction Equity Act of 2008 required group health plans to treat mental health and substance abuse disorders on par with physical illness. “There is a long gestation period on something like this,’’ Hammersla said.
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2. World Health Organization Web site. Obesity:preventing and managing the global epidemic: report of a WHO Consultation (WHO Technical Report Series 894) http://www.who.int/nutrition/publications/obesity/WHO_TRS_894/en/ Accessed September 1, 2013.
3. American Obesity Treatment Association website. Internal Revenue Service Ruling 2002-19. www.americanobesity.org/irsruling.htm Accessed September 3, 2013.
4. FDA Web site. Crawford, L. Combating the Nation’s Obesity Epidemic. Testimony before the House Committee on Government Reform. June 3, 2004. http://www.fda.gov/NewsEvents/Testimony/ucm113779.htm Accessed September 1, 2013.
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06-20-ama-policy-addresses-obesity.page. Accessed September 3, 2013.
8. CDC Web site. Obesity and Overweight. http://www.cdc.gov/obesity/data/facts.html. Accessed Sept. 3, 2013.
9. Harvard School of Public Health website. Paying the Price for those Extra Pounds. Obesity Prevention Source. http://www.hsph.harvard.edu/obesity-prevention-source/obesity-consequences/
economic/ Accessed September 3, 2013.
10. Gallup website. Public: lifestyle, not disease, causes obesity. http://www.gallup.com/poll/12661/public-lifestyle-disease-causesobesity.aspx Press release. Accessed September 3. 2013
11. Japsen B. AMA’s obesity-as-disease vote should boost diet drugs. Forbes. June 19, 2013. http://www.forbes.com/sites/brucejapsen/2013/06/19/amas-obesity-as-diseasevote-should-boost-diet-drugs/. Accessed August 30, 2013.
12. Whittaker v. America’s Car-Mart, Inc. Case:1:13-cv-00108-SNLJ Doc. #: 1 Filed: 07/19/13. US District Court Eastern District of Missouri. http://www.manatt.com/uploadedFiles/Content/
4_News_and_Events/Newsletters/AdvertisingLaw@manatt/Whittakerv.AmericasCar-MartInc. pdf. Accessed September 3, 2013