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BOSTON (State House News Service) - Advocates for obesity care access should get out the word that treatments are not designed for cosmetic, short-term weight loss, the leader of the national Obesity Action Coalition said Wednesday.
A webinar organized by the Massachusetts Coalition for Action on Obesity featured calls to end "bias and stigma" around obesity in an effort to broaden insurance coverage, with some panelists likening their effort to the work around broadening mental health care access.
Chris Gallagher, a coalition policy consultant and veteran D.C. lobbyist, recalled a conversation about Affordable Care Act essential health benefits with a Congressional staffer. There was no separate category for obesity care, and Gallagher asked the aide why there were already categories for mental health care and substance use.
"And his response was, 'Well, because of bias and stigma,'" Gallagher said. " ... And you sit there and say, don't you get it? You get it, we know you get it for mental health. But you're not recognizing it for where we are in obesity."
He called those misconceptions the "biggest stumbling block."
Other panelists also pushed back on what they said were common misconceptions, such as that people seeking obesity care just want to be "thin" or comparable to the cover stars of health magazines.
"I think by the time most of my patients come to me, most of my adult patients, they have struggled for a long time. And I can only think of one patient who ever wanted me to make her 'thin,'" said Dr. Verlyn Warrington, a Pennsylvania-based bariatric medicine director. "They all want to be healthy, and they all want that quality of life."
Warrington said a patient's goals could include playing with their children, or being able to take grandchildren to an amusement park.
"So the conversations we have don't center around vanity, or size this or size that. ... It's about looking at that person get to enjoy their life," she said.
Some insurance carriers cover treatment with her Pennsylvania office, but once the patient's body mass index drops to a certain level, the care is no longer covered.
That's a problem, Warrington said, because obesity is a "relapsing disease" and ongoing preventative measures could be needed. She compared the situation to a diabetic person no longer receiving medicine because their blood sugar reached a healthy level.
The Obesity Action Coalition's CEO, Joseph Nadglowski, emphasized that advocates should "message" that obesity medicines are not designed for short-term weight loss, or losing only 5 to 10 pounds. They're designed for chronic problems and significant percentages of body weight, he said.
Gallagher said Medicare has covered some components of obesity care, like intensive behavioral therapy and bariatric surgery. But Medicare also has "a very dated exclusion on FDA-approved drugs for anti-obesity medications," he added.
That prohibition, which he said has been present since Medicare Part D was created and dates back in some form to the early 1990s, is "extremely problematic, because as many people know, as Medicare goes in terms of coverage, so do private health plans."
Gallagher pointed to the Treat and Reduce Obesity Act, federal legislation that saw no action in the last Congress, as a way to lift Medicare's prohibition on so-called weight loss or weight gain drugs.
At the state level, a Sen. Adam Gomez bill mentioned Wednesday (SD 743 / HD 3858) would focus on opening up Medicaid and MassHealth coverage for obesity therapies.
Under the bill, the state Division of Medical Assistance would "require comprehensive coverage for treatment of obesity," including "coverage for prevention and wellness, nutrition counseling, intensive behavioral therapy, bariatric surgery, and FDA-approved anti-obesity medication."
Dr. Angela Fitch, chief medical officer at Boston-based health care startup knownwell, said Massachusetts has "better coverage" than in her former home of Ohio -- it's one of the reasons she moved to the Bay State.
"We're very fortunate that our state employees have coverage, much like now the federal employee insurance plan has also added it this year, which was exciting. ... Most of our major commercial plans, also, our people have coverage," said Fitch, who also serves as president of the Obesity Medicine Association.
She said work remains to be done in Massachusetts, where there is already "a lot of good movement in that area. And that's why we're here, because of the Senate bill ... and the fact that MassHealth in and of themselves are working in the regulatory space in order to make some of these changes."
Nadglowski said that "somehow, our payment system has made people earn the right to have obesity care, instead of freely giving it" -- and with that comes a missed opportunity.
"Forty-three percent of people have obesity, and honestly, it's costing this nation and world a large amount of money," he said. "And if we could give people better options, or give them easier access to these options, maybe we could address some of those cost issues -- and, of course, improve people's health and improve their lives."
Written By Sam Doran/SHNS
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