The Final Frontier: Access to Care

Lloyd Stegemann, MD, FASMBS

The field of obesity medicine has grown greatly over the last decade. While we still have much to learn, our understanding of the biochemistry, physiology and behaviors that lead individuals to gaining weight has never been clearer. With these discoveries, new therapies have emerged to help individuals take control of their weight and improve their health.

We have new medicines that target specific parts of the body to help individuals control their appetite and cravings, leading to significant weight-loss. New technologies and improved ways of tracking progress have made bariatric surgery safer than it has ever been. Study, after study, after study has come out, showing that weight-loss, whether medical or surgical, improves your health, your quality of life and your life span.

But do you know what hasn’t changed in obesity medicine over the last decade? The opportunity for people to access these life-changing, life-enhancing advances. If anything, access to obesity treatments has become MORE restrictive over the last decade. We are seeing a disturbing trend across the country as employers and insurance companies completely exclude obesity management services and place significant barriers in front of individuals before they can use their insurance to help cover the cost of weight counseling, medications or surgery.

This has never made sense to me. You can’t pick up a magazine, turn on the television, or look at the internet without seeing a story about the “obesity epidemic” in the United States. By any measure you want to check it is clear that America has a weight problem, and we know that as someone’s weight increases they are at risk for developing weight-related problems like diabetes, high blood pressure, obstructive sleep apnea, heart disease and countless other medical issues. We are constantly being bombarded by the message “Lose weight and improve your health!”

So what happens to the person who says “You know what, I’m ready to take control of my weight. I’m going to talk to my doctor about my options.” They go see their doctor, who can’t bill them for their visit, and the patient can’t afford the weight-loss medication or bariatric operation the doctor suggests because it is not covered by their insurance — and neither is the dietary, behavioral and exercise counseling suggested by the physician.

For many individuals, paying cash for these services is not an option. One of my patients once told me “Look, my weight is important to me but keeping a roof over my family’s head is WAY more important to me.” How can you argue with that?

Is it just me, or does it seem absolutely, positively, and without a doubt like lunacy that an insurance company will pay for diabetes medications, CPAP machines, high blood pressure pills, knee replacements, heart surgery, etc., but they won’t pay for the weight-loss therapies that can prevent ALL of those conditions? It’s not right, and it needs to stop. It is equally appalling to treat individuals with obesity differently than you would treat others under the same policy.

For example, I may want one of my patients to undergo bariatric surgery, and their insurance plan puts requirements such as they have to have been affected by severe obesity for at least five years, they have to participate in a 6-month structured dietary program (that their insurance won’t pay for) and they have to pay a separate “bariatric surgery deductible” that is two to three times their normal insurance deductible.  Yet, if I just want to remove this same patient’s gallbladder, I can do it tomorrow! This is wrong and it needs to stop.

The OAC is working aggressively to address these injustices but they certainly can’t do it alone. Just like a powerful wave is made from gathering more and more particles of water, a change of the magnitude I am talking about will take a movement of people. When enough individuals take the time and effort to have their voice heard, that’s when we’ll see change. I hope you’ll join the OAC in being that voice of change.

About the Author:

Dr. Lloyd Stegemann, MD, FASMBS, is a bariatric surgeon from Corpus Christi, Texas. Dr. Stegemann is an active member in a number of bariatric surgery organizations, and is a National Board Member of the OAC.

One Comment for this Post
  • Amy
    November 13, 2015 at 12:46 pm

    This article almost made me cry because of how true it is! I can’t get the type of dietician supervision I am comfortable with because Medicaid won’t cover any dietician appointments. Thank you for this passionate piece that speaks so clearly about this very real concern.

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