New Study & Interactive Map: Obesity Coverage Improved over a Decade in State-Funded Insurance Plans

WASHINGTON, DC (Nov. 14, 2018) – As adult obesity rates continue to increase across the U.S., access to recommended, evidence-based treatments are essential to improve health outcomes, halt the development of associated diseases like diabetes, and reduce costs. New research from the STOP Obesity Alliance (STOP) at the George Washington University Milken Institute School of Public Health (GW Milken Institute SPH) assessed coverage of obesity prevention and treatment in state Medicaid and state employee health insurance plans. The costs of obesity and its consequences – which include diabetes, heart disease, depression, and some cancers – are substantial. States pay for these costs through their state employee insurance and Medicaid plans.

The STOP research found that coverage of three recommended types of obesity treatment – nutritional counseling, medications, and bariatric surgery – generally improved over the last decade. Nonetheless, state coverage is often piecemeal and inconsistent, and barriers exist within plans that prevent people with obesity from accessing evidence-based, effective treatments. The findings in an article entitled “Changes in Coverage for Obesity Prevention and Treatment Services: Analysis of Medicaid and State Employee Health Insurance Programs,” are published online today in the journal Obesity and have been recognized for providing “the latest insights into preventing and treating obesity” as part of the Obesity Journal Symposium at ObesityWeek 2018.

In addition to the published findings, STOP has developed an interactive map to enable easy state-to-state comparisons. The map includes state adult obesity and diabetes rates, coverage specifics in Medicaid and state employee health plans, and printable state fact sheets. Click here to view an image of the interactive map.

“Approximately 93 million U.S. adults have obesity and 7.4 million are more than 100 pounds overweight; the gulf between the need for treatment and its availability will not be narrowed if states fail to address gaps in coverage and barriers along a continuum of obesity care,” said William Dietz, MD, PhD, Director of the STOP Obesity Alliance and Chair of the Sumner M. Redstone Global Center for Prevention and Wellness at Milken Institute SPH.

Research Findings and STOP Recommendations:

STOP assessed changes in coverage for three recommended types of obesity treatment – nutritional counseling, medication and bariatric surgery – in 2009 and 2017 in Medicaid and state employee health plans. States support up to 50 percent of Medicaid costs. State employee health plans cover state government employees – often a state’s largest employer – as well as retiree benefits, where obesity-related costs are especially high. Rising state retiree health costs has resulted in states trimming their budgets in other areas.

Key Overarching Findings:

  • Obesity coverage improved overall in state Medicaid and state employer plans between 2009 and 2017.
    • Nutritional counseling coverage increased by 75 percent in state employee health plans (24 to 42 states) and 133 percent in Medicaid (9 to 21 states).
    • Medication coverage increased by 64 percent in state employee health plans (14 to 23 states) with no net increase in Medicaid (16 states both years).
    • Bariatric surgery coverage increased by 23 percent in state employee health plans (35 to 43 states) and 9 percent in Medicaid (45 to 49 states).
  • Not all states moved in a positive direction. For each of the three treatment types reviewed, a handful of states that indicated coverage in 2009 specifically excluded that coverage in 2017.
    • The negative change was most common for anti-obesity medications, but occurred for bariatric surgery in two state employee plans and for nutritional counseling in two Medicaid plans.
  • Obesity coverage in these state-funded plans was often piecemeal rather than comprehensive. Coverage in 2017 plans often included the two ends of the spectrum – nutritional counseling and bariatric surgery – with scant coverage of medication therapy. Approved medications were often the least effective drugs.
  • Restrictions on covered obesity treatments were common in both Medicaid and state employee plans. For example, eligibility required an obesity-related consequence, such as diabetes.
  • Obesity coverage in state employee health plans was generally more comprehensive than in state Medicaid plans, but the plans often differed on what is covered.
  • Among the seven states with the highest obesity rates, four have reduced coverage for obesity treatment.
    • Louisiana Medicaid indicated coverage for nutritional counseling in 2009, but not in 2017.
    • Iowa Medicaid indicated coverage for obesity medication in 2009, but not in 2017.
    • Alabama and Arkansas state employee health plans indicated coverage for obesity medication in 2009, but not in 2017.

Key STOP Recommendations for State-Funded Coverage Plans:

  • As recognized by the American Medical Association, state Medicaid manuals should explicitly state that obesity is a disease.
  • States should provide comprehensive coverage for treatments along the obesity care continuum as recommended by evidence-based clinical practice guidelines.
  • Medicaid and state employer plans should be consistent, making it easier for providers to know what is covered, and thereby, how best to advise treatment; New Jersey is the only state with such consistency.
  • States should also ensure providers know what is covered through explanation and dissemination of provider manuals.

​​Our research identifies opportunities for states to reduce the costly burden of obesity and other related diseases,” Dietz added. “These state coverage changes, paired with the explicit recognition of obesity as a disease – and the broader elimination of bias and stigma toward people with obesity – will be necessary to make real headway in reversing the obesity epidemic.” 

The study, “Changes in Coverage for Obesity Prevention and Treatment Services: Analysis of Medicaid and State Employee Health Insurance Programs,” was conducted with support from Novo Nordisk Inc.