Advocating for Coverage of Obesity Treatments

Letter from the President

TOS eNews - February 19, 2014

 

Dear Colleagues,

 steven smith-5x7 5-new

Millions of Americans continue to be denied health insurance coverage for legitimate and proven obesity treatments. Combine that with projections that one-in-ten Americans will have severe obesity in 2030 and we continue to scratch our heads and ask “why?” And, what can we do as TOS members to make a difference?

 

The real answers are not as simple as some might argue. The most common argument against access to these treatments is cost. But, as we peel back the onion we find other reasons that are even more complex.  

 

Let’s talk about cost. Each year, innovative new treatments are introduced into the medical armamentarium across the entire spectrum of diseases. Obesity is no exception. Bariatric surgery is generally safe, and most often effective, and we will soon have as many as four FDA-approved drugs for obesity treatment on the market. These treatments offer hope to patients with obesity, but there is no denying the high costs.

 

Dr. John Morton, TOS member and professor of surgery at Stanford University, recently said in an Associated Press story on the topic: “If we were talking about breast cancer, no one would be content with having only one percent of that population treated." He was speaking specifically about the limited insurance coverage for bariatric surgery, but the concept applies across the spectrum of obesity treatments.

 

TOS, as a leader in the Obesity Care Continuum, has taken an active role in change by advocating for better access to obesity treatments. As we continue to work to improve access for persons with obesity on the Hill, we emphasize that not treating obesity is expensive and, importantly, that we do not deny persons with other medical illnesses access to safe and effective treatments.

 

But, the issue is more complicated than an economic analysis. When Medicare Part D, which provides prescription drug coverage, was written into law obesity treatments were one of only three classes of medications that were excluded. Depression drugs were also excluded and the coverage ban has since been lifted.  

 

We continue to observe that societal and personal biases, leading to both overt and covert discrimination, are key factors in this exclusion. Indeed, it will take time to move the needle, and we are already seeing progress in this area.  

 

As TOS members, you have an important role to play - not only in your daily life, but also to actively speak clearly when you see bias and discrimination. As you interact with the lay public, work with other professionals, and hopefully bend the ear of policy makers - speak about the biological basis of obesity and explain the complexity of the disease. Highlight that the things we know are effective for the prevention of weight gain, and do not always work once obesity is established. I find that the latter fact is a real eye opener for many professionals and other members of the lay public. Not smoking is effective for preventing lung cancer, but once established… I think you see my point.

 

At TOS we continue to advocate for change and are committed to finding new ways to join forces and extend our reach in advocacy. We are, in fact, expanding our efforts to include advocacy at the state level. We are taking this route because in the Affordable Care Act decisions about coverage for obesity treatments have been pushed out to the state level. There is much to do in this space and many of you will be called on to act locally. Stay tuned.

 

Lastly, I want to recognize the key role that every TOS member has in the dialogue about access to obesity treatments.

 

  • To our basic researchers: we need you to continue to seek fundamental knowledge about how and why obesity develops and to make discoveries that lead to innovative and effective treatments.
  • To our translational – clinical researchers: we must pull these ideas into the clinic and share clinical problems with basic scientists so they are working on the right questions.
  • To our members who work in the area of behavior: continue to seek effective strategies and approaches to create change.  
  • To our clinical professionals: we must continue to generate data supporting the risks, benefits, and costs of novel treatments; and, continue to actively pursue more effective prevention to bend the curve back in the right direction.

 

In short, each and every TOS member has a role to play in advocacy. Let’s go for it.

 

Sincerely,

 

 

Steven Smith, MD

TOS President

(Please note: External Links are provided as a courtesy. The Obesity Society is not responsible for the content on sites accessed through external links.)

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