Study Details Improvements and Needs in Obesity Prevention and Treatment Coverage

Over the past decade, many state programs began covering nutrition counseling

Between 2009 and 2017, the proportion of state employee and Medicaid programs indicating coverage for proven obesity and prevention services increased substantially, according to new George Washington University Milken Institute School of Public Health (Milken Institute SPH) research. In addition to detailing the coverage increases, the study also highlights treatment gaps. All of the data are accessible on interactive maps designed to enable easy state-by-state comparisons.

“Obesity is a serious chronic disease that affects more than one-third of adult Americans, and it is one of the most significant public health challenges facing the United States,” says William Dietz, MD, the study’s senior author and director of the Sumner M. Redstone Global Center for Prevention and Wellness (Redstone Center) and Strategies to Overcome and Prevent Obesity Alliance at the Milken Institute SPH. “Our country spends more than $200 billion annually on medical treatment related to obesity and its impacts each year. Medicaid and Medicare pay for nearly half the direct medical costs of overweight and obesity.”

Redstone Center researchers completed an extensive review of publicly-available documents and documentation associated with the Medicaid and state employee health insurance programs in all 50 states, plus the District of Columbia. “We also included some of the managed care organizations contracted to work with the states that had more than 75 percent of their adult Medicaid beneficiaries enrolled in managed care,” says Nichole Jannah, the study’s lead author and creator of the interactive maps.

The team found that state employee programs logged more improvements in obesity prevention and treatment services between plans offered in 2009 and ones offered in 2017 than Medicaid programs. Key findings include:

  • The proportion of state employee programs indicating coverage increased by 75 percent for nutritional counseling (from 24 to 42 states), 64 percent for pharmacotherapy (from 14 to 23 states), and 23 percent for bariatric surgery (from 35 to 43 states).
  • The proportion of Medicaid programs indicating coverage increased by 122 percent for nutritional counseling (from nine to 20 states) and 9 percent for bariatric surgery (from 45 to 49 states), with no apparent increase in coverage for pharmacotherapy (16 states in both plan years).
  • The number of states that appeared to provide comprehensive coverage for adult obesity treatment modalities—including possible coverage for nutritional/behavioral counseling, pharmacotherapy, and bariatric surgery—increased from four to six states for Medicaid programs and from seven to 19 states for state employee programs.

“While what we found is encouraging, in that all Medicaid and state employee plans covered at least one obesity treatment, few states appeared to offer comprehensive coverage for all medically appropriate services,” the authors write. “These results highlight a problematic treatment gap. Coverage is available for lifestyle interventions that are effective for treating mild obesity and bariatric surgery, which is effective for treating severe obesity. However, pharmacologic and medical treatments that may be most appropriate for individuals with moderate obesity and a history of unsuccessful weight management efforts are covered least frequently. Although primary prevention must be a high priority, uniform coverage of evidence-based treatment modalities is essential to effectively manage patients with obesity.”

The research team recommends that associations representing state employees and other interested groups educate lawmakers and program administrators about the physiological basis of obesity and the evidence showing the safety and effectiveness of obesity treatments. 

The interactive maps published in tandem with the peer-reviewed research enable visitors to view breakdowns of obesity treatment and service offered through Medicaid and state employee coverage for each state in two separate maps.

Coverage for Obesity Prevention and Treatment Services: Analysis of Medicaid and State Employee Health Insurance Programs” is published in Obesity.  In addition to Jannah and Dietz, the authors are Jeff Hild and Christine Gallagher of the Redstone Center.