There’s little doubt obesity has hit epidemic levels in the U.S. with an estimated 12.7 million obese children (17%) and 78.6 million obese adults (34.9%), according to CDC data. Obesity-related conditions, such as heart disease, stroke, and type 2 diabetes are among the leading causes of preventable death. In fact, obesity is second only to tobacco in the number of deaths it causes per year in the U.S. In addition, obesity, (having a Body Mass Index of 30 or higher) is one of the most common disqualifiers for military service, affecting 25% who apply. And it doesn’t look like the numbers will drop anytime soon, a Robert Wood Johnson Foundation 2012 report estimates 44% of adults will be obese by 2030.
The price tag of obesity is staggering - close to $305.1 billion a year in healthcare costs - which places a huge burden on Medicare and Medicaid. The Brookings Institute released an analysis last year which put obesity costs of the two programs at $91.6 billion a year. The study authors commented, “These high fiscal costs also suggest that initiatives to prevent and reduce obesity should be a public-sector priority as lower obesity can not only improve Americans' health but also substantially lower government spending on health programs.”
Medicare recognized obesity as a medical condition in 2004, which provided greater coverage for obesity treatments. Then in 2011, Medicare started paying for full preventive services including counseling and behavioral interventions. Under ACA guidelines effective this year, many states opted to include obesity treatment into marketplace health plans. There are currently 36 states plus the District of Columbia that offer some type of weight loss treatment as an “Essential Health Benefit” (EHB), according to the National Obesity Foundation.
Yet, 27 states don’t cover bariatric surgery, a proven effective treatment for those with morbid obesity. This prompted five medical groups to recently file a complaint with HHS stating those states are not in compliance with the ACA and violate the ban against denying coverage for a pre-existing condition. As previously reported in Healthcare Dive, the American Society for Metabolic and Bariatric Surgery (ASMBS) estimates there are 24 million severe or morbidly obese Americans.
Surprisingly, there are 14 states which offer no obesity treatment or counseling via such states' marketplaces. This includes Mississippi which had ranked as the state with the highest obesity rate (35.5%) in the U.S. for 10 years running. However, just this past year, Mississippi slipped into third place with Arkansas moving into first place with a 35.9% obesity rate, followed by West Virginia with a 35.7% obesity rate. Colorado has the lowest obesity rate nationwide at 21.3%. It’s shocking to read that 22 states have an adult obesity rate of 30% or more.
Obesity on the job
Obesity costs businesses big money. According to a report by Kaiser Permanente, the disease racks up more than $73 billion a year in not only healthcare costs but also in lower productivity. Many experts say employers should invest in employees’ health since the CDC estimates obese employees cost $1,400 more in annual medical costs than non-obese employees. Also, absenteeism is higher in obese workers, who average being absent one week more each year versus other non-obese employees. The report stated less than one-third of private sector employees have access to employer-sponsored workplace wellness programs.
That's unfortunate because workplace wellness programs do seem to be effective. A 2010 study by Harvard University researchers found such programs can generate substantial savings. Medical costs fell $3.27 for every dollar spent on wellness programs and absenteeism costs fell $2.37 for every dollar spent. This is important because a study conducted by Columbia researcher Dr. Claire Wang last year found that obesity is associated with a significant increase in lost workdays – from 1.1 to 1.7 extra days missed per year compared to normal-weight employees. Nationwide, obesity-related absenteeism costs an estimated $8.65 billion annually. If that’s not enough to convince employers to implement some type of wellness program, another study showed overweight to morbidly obese employees cost between $4,252 and $8,067 per year in health costs versus $3,838 per year for normal-weight employees.
New treatments on the horizon
Despite patient education, behavior modification, exercise, diet, and employer wellness programs, many obese Americans still struggle with losing weight. At that point, a physician may suggest some of the new obesity treatment options. The latest FDA-approved device is a tiny pacemaker-like unit called the MAESTRO System that controls hunger by blocking the vagus nerve in a process called vBloc neurometabolic therapy. Developed by EnteroMedics, the system is reversible and is implanted in an outpatient procedure. The company stated in their third quarter 2015 financial report CMS has made a final decision for the device’s payment policy to be effective Jan. 1, 2016.
Several obesity drugs have been recently approved by the FDA including two this year: Saxenda (injection) and Contrave, Belviq in 2013 and Qsymia in 2012. However, sales have been disappointing because of the drugs’ potential side effects - ranging from blurred vision and chest pains to seizures and suicidial tendencies – as well as the fact many insurance companies won’t pay for them.
A double balloon filled with saline called ReShape Integrated Dual Balloon System that’s put in the stomach for six months was approved by the FDA in July. Already approved in Europe, a clinical trial in the U.S. in obese patients showed those who received it lost more weight than those who only received counseling. There are two other balloons in clinical trials as well as a liner, called EndoBarrier, that blocks food from a part of the intestinal wall. It’s currently in clinical trials to treat type 2 diabetes in obese patients.
The almost 79 million obese Americans represent a huge potential market for the next obesity medication or device that's safe and effective. Scientists announced they have discovered how a gene linked to obesity makes people fat – perhaps the key to a new treatment beyond diet and exercise. Lead investigator Melina Claussnitzer, a genetics specialist at Beth Israel Deaconess Medical Center told CBS News, “for the first time, genetics has revealed a mechanism in obesity that was not really suspected before.”
It seems there may never be a magic bullet to treat obesity, but many experts say what is really important is comprehensive weight-loss programs. Dr. Dan Blumenthal, president of the American College of Preventative Medicine, recently commented in his blog, Morning Consult, “Numbers can bring awareness to public health trends like obesity, but we cannot stop there. Improving health and health outcomes requires understanding and compassionate care for the people behind the statistics.”