ISO--In Search of...Answers: Why Don't Insurance Plans Pay for Weight Maintenance Programs and Obesity Prevention Programs?

America's health care system is in crisis precisely because we systematically neglect wellness and prevention.

--Tom Harkin

It seems as though some insurance plans are now paying for weight-loss programs, but why not help the medical community by setting up preventive programs that could work toward preventing obesity in the first place? How about maintenance programs for those who have recently lost weight and reached goal weight?

Children, it would seem, are at the most risk for obesity, and reaching them at an early age is crucial. Besides, the younger they are, the easier kids adapt to gradual changes in their diet, although I would not support a program that would embarrass and/or demean them in any way.

In addition, older people who were thin in childhood and early adulthood can also begin gaining weight in middle age and eventually become obese. Why wait until someone becomes obese before intervention? Why not start an adult education and screening program, designed especially for at-risk adults? After all, it's easier to lose 10-25 pounds than 100-300 pounds.

Get the word out via TV and internet public service commercials. In short, the medical community needs to get involved in free or low-cost clinics for obesity prevention and then weight maintenance.

As much as I love Weight Watchers, its maintenance program seems lacking in significant ways. Yes, Lifetimers who maintain their goal weight are allowed to attend meetings for free, but the meetings themselves are really designed for weight-loss members, not weight maintenance members, who have different needs from the weight-loss group. Lifetimers often stumble and become WW repeaters (like me), which, on the surface, might mean more profit for WW, but if you think about it not very good public relations.

Also, free weigh-ins for Lifetimers are allowed only once a month, which seems a long time between weigh-ins, for one can gain 5-10 pounds in a month! (Within that month, maintainers can attend as many free meetings as they wish--they just can't weigh in).

The maintenance phase is a very vulnerable time for members who have just reached goal because they are now dealing with handling extra points and a growing realization that maintenance must be forever if one is to keep the weight off. In addition, it's more difficult to maintain a weight than it is to lose it--and not as "sexy." Eventually, the new thin you becomes just ordinary you, for you still have many of the same problems, such as bills, family stuff, work difficulties, etc. Also, there is a sort of mourning period for "what was" before weight loss, mainly unfettered eating, which offered a now-missing pleasure. If you don't recognize this fact, then you are likely to regain some or all of the excess weight, perhaps even more weight.

My idea: perhaps WW could partner with the medical community to set up maintenance programs for new maintainers, either free or reduced costs. Also, perhaps insurance companies ought to consider covering weight-loss and maintenance programs for everyone who is or was overweight, not just at-risk people. After all, if you can prevent obesity-related diseases by preventing obesity, wouldn't that ultimately save money for the insurance companies?

An example of crazy insurance rules: when I was 20 (in the 1970's), I needed to have my wisdom teeth removed; they were growing in sideways, pushing my teeth together, and causing me great pain. The only way that the insurance company would cover the procedure: I would need to be admitted to the hospital and be placed under general anesthesia (the knock-out kind, which I really didn't want); otherwise, I would have had to pay for it myself. My then-husband and I didn't have two nickels to rub together, so I went into the hospital, admitted the day before the procedure and discharged the day after it was done. Our insurance company paid the entire bill.

Isn't that insane? Had the insurance company simply paid the in-office costs, the company would have paid 1/10th of the hospital bill. Even at 20, I could see how insurance costs would steadily rise with such ridiculous policies, and so they did. Eventually, insurance companies got smart and started to cover some in-office procedures.

Now insurance companies will cover weight-loss surgery and diet programs only if these programs and procedures are "medically needed." Why not cover weight-loss programs before they are "medically needed"? Why not prevent obesity, high blood pressure, heart problems, and Type 2 Diabetes before they occur?

Comments?