In the Journals Plus

Insurance coverage not associated with results in weight management program

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May 30, 2017

Adults with obesity who had access to a health care benefit that covered medical weight management lost the same amount of weight as patients who paid out-of-pocket for the same program, according to findings published in Obesity.

“The perception that personal responsibility is the primary driving factor for obesity remains pervasive, and this may influence insurance coverage, shifting treatment costs to the patient (ie, more ‘skin in the game’),” Jamy D. Ard, MD, associate professor in epidemiology and prevention at the Weight Management Center at the Wake Forest School of Medicine in Winston-Salem, North Carolina, and colleagues wrote. “Some believe that considering obesity a disease, which potentially increases coverage for treatment options, will lead to less individual responsibility and treatment adherence.”

Using electronic medical records, Ard and colleagues analyzed 1-year outcomes from 943 adults with obesity participating in the By Design Optifast (52 weeks) or By Design Essentials (24 weeks) weight-loss programs at the Wake Forest Baptist Health Weight Management Center between January 2013 and June 2015. Researchers compared two groups: employees with insurance coverage (n = 480) and nonemployees who were not covered and paid out of pocket for care (n = 463). For the By Design Optifast program, out-of-pocket costs for self-pay patients were $2,730, plus the cost of meal replacements; patients with insurance paid $345 plus cost of meal replacements. For the By Design Essentials program, out-of-pocket cost for self-pay patients was $480 plus copays; those with insurance paid $246. Patients entered the programs through physician referral or self-referral. Researchers assessed weight and demographic information; socioeconomic status was estimated using neighborhood demographics. Researchers used linear models to assess group differences in weight.

Compared with self-pay patients, patients with insurance tended to be approximately 5 years younger (mean age, 47 years vs. 52 years) and had a lower mean BMI at enrollment (38.5 kg/m² vs. 41.3 kg/m²). Patients who paid out of pocket lived in higher annual per capita income neighborhoods (P < .001).

Patients who had insurance were less likely to drop out of the program vs. those who paid out of pocket (12.7% vs. 17.6%; P = .03); the overall dropout rate was 15.2%. Insurance status did not affect overall weight loss, according to the researchers. Self-pay patients lost a mean of 13.6% of body weight, whereas patients with insurance coverage lost a mean 13.4% of body weight; similar proportions of patients lost 5% and 10% of body weight, and estimated mean weight loss did not change when dropouts were included in the model (P = .65).

“Ultimately, there may not be a need to create additional motivation for people who self-select into a comprehensive medical weight-loss treatment — instead, what we need to better understand are the primary drivers of motivation and barriers to initially seek treatment in such programs,” the researchers wrote.

The researchers added that future research should assess how insurance coverage affects initial motivation to seek treatment. – by Regina Schaffer

Disclosure: The study was partially funded by a grant from Nestle Health Sciences.