Health Insurance & Obesity

Obesity is expensive. That was the message from a government-sponsored study in 2009 that found the health care costs associated with obesity in the United States had reached nearly $150 billion a year. The study found that obesity was responsible for more than 9 percent of all medical costs and that an obese person's health care costs are about 40 percent higher than a non-obese person's. It's no surprise, then, that obesity is a hot-button issue for health insurers.

Prevalence

Obesity is medically determined by body mass index, or BMI, a ratio of weight to height. A person with a BMI of 25 or higher is considered overweight; a BMI of 30 or higher is obese. A 2010 study published in the Journal of the American Medical Association reports that 68 percent of Americans are overweight, with 33 percent overweight to the point of obesity. Obesity significantly raises your risk of some of the biggest killers: heart disease, high blood pressure, cancer, stroke and type 2 diabetes, as well as a host of other medical conditions.

Coverage

Health insurance policies regularly cover conditions brought on by obesity--heart attacks and high blood pressure, for instance. But coverage for measures that would prevent or reduce obesity itself can best be described as inconsistent. A study of insurers in Pennsylvania published in the Journal of the American Dietetic Association found that all surveyed plans offered some coverage for surgical procedures, such as bariatric surgery, which reduces the size of the stomach. But fewer paid for weight-loss counseling, and non-surgical treatments were covered by less than half.

Reluctance

The American Obesity Association cites three main reasons why insurers may be reluctant to cover obesity treatments. The first could be referred to as the "diets don't work" argument: because so many people view weight-loss programs as ineffective, covering them might be a poor use of limited resources. Second is the sheer scope of the problem: if one-third of the covered population is obese, then one-third of the population could start filing costly claims for obesity treatments. The final reason is what the association calls "perhaps the most significant obstacle" to coverage: public attitudes, right or wrong, toward obesity. Regardless of how the medical establishment views obesity, a widespread public view remains that what obese people need is not medical intervention but a dose of personal responsibility and self-control.

Premiums

In general, obese people are not subject to higher health insurance premiums. Newsweek magazine says the move toward forcing smokers to pay higher premiums may well set a precedent for charging obese people more as well. But an analysis by Slate magazine suggests that such a move might be illegal; if a person can prove he has done everything he can to lose weight but is still obese, a higher premium could amount to discrimination based on genetics.

Trends

Health care reform legislation passed in 2010 requires insurers to cover preventive screening, such as for obesity, but it does not mandate coverage for specific obesity treatments.