Paying for Weight Loss Care vs Insurance Brings Same Results, Study Finds

The American Medical Association declared obesity a disease in 2013, but insurers have been slow to cover drugs to treat the disease.

Overweight patients whose insurance paid for a comprehensive medical weight loss program made the same progress after a year as those who covered the cost out of pocket, according to a study reported in the journal Obesity.

Researchers reviewed electronic medical records from 943 patients who took part in nonsurgical weight loss programs at Wake Forest Baptist’s Weight Management Center between January 2013 and June 2015. The patients included 480 whose insurance covered their participation and 463 who paid out of pocket.

The groups were well-matched by age and ethnicity, but those with insurance were a bit younger, started with a lower body mass index, and lived in poorer neighborhoods.

After 12 months, the group covered by insurance had a mean weight loss of 13.4%, while those who paid for their own care lost 13.6% of body weight. Similar percentages of each group lost at least 5% or more of their baseline weight—a critical measure, since weight loss of this amount is considered “transformational” and is the goal for the National Diabetes Prevention Program.

Researchers did find that the group whose insurance paid for the program had a lower average drop rate—12.7%, compared with 17.6% for those who paid their own way.

Lead author Jamy Ard, MD, a co-director of Wake Forest’s Weight Management Center, said the findings run counter to myths about what it takes to get people to lose weight.

“There’s a rather pervasive idea that patients who pay more out of pocket for a weight loss program, who have more ‘skin in the game’ so to speak, will be more engaged in the treatment and consequently have better outcomes than people whose treatment is covered by insurance,” he said in a statement.

“This is especially important as we try to expand coverage for obesity treatment and stem the tide of the obesity epidemic,” Ard said.

While coverage for obesity care is improving, advocates for patients have said that insurers often fail to put obesity on par with other chronic diseases, even though they end up paying for its complications. The American Medical Association declared obesity a disease in June 2013, but many insurers have been slow to approve therapies to treat it.


Ard J, Emery M, Cook M, et al. Skin in the game? Does paying for obesity treatment out of pocket lead to better outcomes compared to insurance coverage (published online May 24, 2017]. Obesity. 2017; DOI: 10.1002/oby.21837

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