According to the Centers for Disease Control and Prevention (CDC), 69 percent of Americans are overweight or obese. The average person weighs 23 pounds more than they should. For many people, factors like family history, metabolism, exercise, eating habits, lifestyle and stress can make maintaining a healthy weight difficult. Unfortunately, social stigma and misinformation continue to surround obesity treatment and prevention.
It’s an issue we can’t ignore, however. The negative impacts of obesity on health are well documented. Obese people suffer from higher rates of diabetes, high blood pressure, high cholesterol, sleep apnea, and other health problems. The personal and societal costs of obesity are also significant. Each year, obesity costs the United States an estimated $190 billion in medical costs alone (Reuters, 2012).
Lifestyle changes are the first and most important step in the weight-loss journey. Numerous clinical studies show that a healthy diet and exercise are effective in fighting weight gain. Many programs are available through health plans, doctors, employers and the community. Mobile apps and online resources also have useful information and tools to support diet and exercise routines. But many people need solutions in addition to diet and exercise. At Aetna, we hear from members who actively participate in exercise and diet programs, but they are not seeing significant results. They want more information on options like prescription drugs and surgery. For them, finding the right information and resources can be difficult and frustrating.
Anyone considering significant weight loss should see a doctor first. Doctors can help patients understand their personal health issues and customize a weight-loss program that is right for them. Additionally, prescription drugs and surgical options require that doctors make sure patients meet clinical guidelines for safety and effectiveness. They will also monitor patients’ progress. Like all drugs and medical procedures, weight-loss treatments may include side effects and risks.
In addition to primary care doctors, bariatric and weight-loss specialists also may provide counsel on lifestyle changes, prescription medicine and surgery. Before an appointment, it is a good idea to confirm the areas of treatment that the doctor will discuss.
Health plan members can find doctors who participate in their plan’s networks by calling member services or checking available online directories, such as Aetna DocFind. The American Society of Bariatric Physicians (ASBP) also maintains a listing of doctors who self-identify as specializing in weight loss at www.FindObesityTreatment.org. (ASBP is not associated with Aetna or other health plans. Before seeing an ASBP specialist, health plan members should make sure the doctor is in their plan’s network.)
Most importantly, anyone who wants to be healthier should know it is never too late to start and help is available.
Combining weight loss approaches for greater impact
While healthy lifestyle and wellness programs are common features of health plans, prescription weight-loss drugs and surgical treatments are available as optional benefits for plan sponsors to select. Health benefit plan sponsors say they want more information on the value of the medications and surgical options, their impact on outcomes, and the potential for medical cost offsets. In addition, many doctors are cautious about prescribing weight-loss drugs because of safety issues with older medications. Additional experience and evaluation of medical weight-loss options can provide more information that can help consumers, doctors and plan sponsors make informed decisions about their use and coverage.
Aetna is helping add to the evidence base through a pilot program that will evaluate the benefits of new FDA-approved, prescription weight-loss drugs combined with healthy lifestyle. In 2012, the Food and Drug Administration (FDA) approved the drugs Qsymia® and BELVIQ® for weight loss. Studies show that these drugs can help patients lose five to 15 percent of body weight. Study participants also had lower cholesterol, blood pressure and blood sugar. The Aetna pilot is available to self-insured plan sponsors who have or choose to add coverage for weight-loss drugs. (Self-insured health plans can make benefit changes anytime throughout the year. Fully insured plans cannot.)
“We want our employees to have multiple tools to help them lose weight and stay healthy,” said Chelle Turner-Bales, benefits manager for Franklin Electric, a pilot program participant. “We believe that Aetna’s program will benefit those who may need additional help along with diet and exercise while providing more information on the long-term benefits of a healthier, productive workforce.”
Aetna members are automatically enrolled in the pilot when they fill prescriptions for BELVIQ or Qsymia. Doctors must prescribe the medicines according to clinical requirements. According to the Food and Drug Administration (FDA), a person must have a Body Mass Index (BMI) of at least 30 to be eligible to use the drugs. People with a BMI of 27 and at least one other health problem may also qualify. (Other prescription weight-loss drugs may be covered , but only BELVIQ and Qsymia will be evaluated as part of the pilot.) Members are encouraged to talk with their doctors about the weight-loss options.