Lack of Coverage, Diagnoses Keep Those With Obesity From Getting Help

A spokesman for The Obesity Society said that lack of payer coverage for obesity may discourage physicians from recording body mass index and making a formal diagnosis.

Two studies—one of health professionals and one of patients—found that those who should be treated for obesity often lack insurance or fail to even get a correct diagnosis, according to information presented during Obesity Week, which concluded Friday in New Orleans, Louisiana.

The first survey, which gathered information from 450 non-physician health professionals online, found that 57% believe that improved health coverage for weight loss would lead to greater access to care. This finding cuts across all patient income levels. “We found that a quarter of health professionals perceive current insurance coverage to be a weight loss challenge,” said Ruchi Doshi, MPH, of the Johns Hopkins University School of Medicine and the Johns Hopkins Bloomberg School of Public Health, in a statement from The Obesity Society.

The second study found that 3 of 4 patients are affected by being obese or overweight, yet less than half (48%) of those with a body mass index (BMI) of 30 kg/m2 received a formal diagnosis of obesity. The CDC defines a BMI of 30 kg/m2 as obese and a BMI of 25 to 29.9 kg/m2 as overweight.

Scott Kahan, MD, MPH, spokesperson for The Obesity Society and director of the National Center for Weight and Wellness, said not receiving a proper diagnosis or having insurance coverage can prevent those who are overweight or obese from getting help from trained weight-loss professionals. Those with severe obesity in particular benefit from support from specially trained healthcare professionals, he said.

One problem, Kahan said, could be that many health plans do not adequately reimburse physicians for treating obesity, so there is little incentive to take patients’ BMI or properly diagnose obesity. “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 policy makers.”

The second study, which was funded by Novo Nordisk, culled electronic health records from the Cleveland Clinic to see if patients who had a BMI of at least 30 kg/m2 received a diagnosis of obesity using the correct diagnosis code. Even among patients with severe obesity—a BMI of 40 kg/m2—only 75% of the patients’ records showed the diagnosis code.

Findings from the studies are consistent with those presented at Patient-Centered Diabetes Care 2016, presented by The American Journal of Managed Care. At the meeting, Ted Kyle, RPh, MBA, a former chair of the Obesity Action Coalition, said while insurance coverage is improving, significant barriers remain due to stigma. And Janine Kyrillos, MD, of Thomas Jefferson University Hospital, said physicians themselves can be the biggest stumbling blocks to overcoming stigma for patients who need care for obesity.

On the positive side, the American Board of Obesity Medicine, a relatively new accrediting body, has seen the number of diplomates soar since its first class in 2014, when 333 passed an exam for membership. As of 2016, there are 1590 diplomates, mostly from the fields of internal medicine and family practice. Other fields represented are endocrinology, obstetrics/gynecology, pediatrics, psychiatry, and emergency medicine, among others.