1. Essential Health Benefits and Obesity Treatment Coverage

2. Obesity
Life expectancy, smoking prevalence and use of drugs and alcohol have improved over the last three decades
In contrast, obesity prevalence has nearly tripled in the last 50 years
Over 2/3 of Americans are overweight and obese
35.7% of Americans are obese
It is projected that 42% of the population will suffer from obesity by the year 2030
It is major cause of death attributable to heart disease, cancer, and diabetes according to the Centers for Disease Control and Prevention

3. Obesity is a Disease
National Institutes of Health (NIH) recognized obesity as a disease in 1991
American Medical Association (AMA) in 2013 officially recognized obesity as a disease
Governmental agencies recognizing obesity as a disease
US Internal Revenue Service (IRS)
Centers for Medicare & Medicaid Services (CMS)
Other organizations supporting surgical treatment of obesity
American Heart Association (AHA)
American College of Cardiology (ACC)
American Diabetes Association (ADA)
International Diabetes Federation (IDF)

4. Obesity Trends* Among U.S. Adults BRFSS, 1990, 2000, 2010
(*BMI 30, or about 30 lbs. overweight for 5’4” person)
1990
2000
2010
No Data <10% %–14% %–19% %–24% %–29% ≥30%

5. Essential Health Benefits
Ambulatory patient services
Prescription drugs
Rehabilitative and habilitative services and devices
Emergency services
Hospitalization
Laboratory services
Maternity and newborn care
Preventive and wellness services and chronic disease management
Mental health and substance abuse disorder services, including behavioral health treatment
Pediatric services, including oral and vision care

6. Obesity Is Not Covered Under the Essential Health Benefits
Each State decides whether the disease of obesity is a covered benefit within the qualifying health plans participating in the State Health Insurance Exchange
27 states and Washington DC do not cover bariatric surgery
Medical treatment for obesity is a covered benefit in only 5 states

7. Essential Health Benefit Benchmark Plan Coverage of Weight-Related ServicesAK WA MT ME ND MN OR NH ID WI NY VT SD MI MA WY RI PA CT IA NE OH NJ NV IN IL UT WV DE CO VA KS MO KY MD CA NC TN DC OK AR SC AZ NM AL GA MS TX LA HI FL
Does not cover bariatric surgery nor weight loss programs
Covers weight loss programs but does not cover bariatric surgery
Covers bariatric surgery but does not cover weight loss programs
Source: Center for Consumer Information and Insurance Oversight summary of EHB benchmark plans based on 2012 benefits – STOP Obesity Alliance, Weight and the States Policy Research Bulletin, December 2012.
(States that have not selected an EHB benchmark plan defaulting to the largest small-group employer plan in the state.)
Covers bariatric surgery and weight loss programs
Current as of ; Coverage may have changed since this printing

8. Economics of Obesity
Excess weight is responsible for 2.8 million deaths worldwide annually
Obesity accounts for 21% of national health spending
Obesity discrimination plays an important role in lower income and production
9% lower income

9. Economics of Obesity Obese individuals have
42% higher annual healthcare costs
77% higher prescription costs (as high as 105%)
37% higher primary care costs
Obesity raises annual medical costs per obese individual by $2,741 (in 2005 dollars)
Obesity increases lifetime medical costs by 50%

10. Economics of Obesity Productivity Costs
Obese individuals compared to healthy weight individuals have been shown to have
3.73 additional days lost annually
1.23 times higher absenteeism rate
194% more likely to use paid time off
Greater lost productive time while present at work
Bariatric surgery provides immediate benefit by decreasing lost work time and disability
Treatment costs associated with bariatric surgery were relatively small compared to economic losses of not treating obesity

11. Economics of Obesity and Type 2 Diabetes
24 million Americans have Type 2 Diabetes
41% increase in the total costs of treating diabetes was noted from 2007 to 2012
$174 billion to $245 billion

12. Bariatric Surgery Outcomes
Durable weight loss
106 pound mean weight loss after 16 years
Remission of Type-2 diabetes (83%)
Reduction in mortality from diabetes by 78%

13. Bariatric Surgery Outcomes
Resolution of Obesity-related Medical Problems
High blood pressure %
Sleep apnea %
High cholesterol %
Asthma %
Gastroesophageal reflux %
Arthritis of weight-bearing joints 61.4%

14. Bariatric Surgery for Type-2 Diabetes
Lifetime costs to medically treat a patient with Type-2 diabetes is approximately $300,000
compared to approximately $25,000 for bariatric surgery
Total health care costs
Increased 9.7% in the first year after surgery, but
Decreased by 34.2% and 70.5% in years 2 and 3 after surgery
Life expectancy is improved in bariatric surgery patients when compared to medically managed patients
Several studies show increased short-term medical costs are increased, but at an acceptable level of cost effectiveness (given that the guideline for cost-effectiveness in the United States is less than $50,000/quality-adjusted life years)
$21,973/quality-adjusted life years (QALY)
$7,000-$9,000/QALY for gastric bypass surgery
$11,000-$13,000/QALY for gastric banding surgery

15. Cost Effectiveness Analysis
Compared 3651 bariatric surgery patients and 3651 matched surgery-eligible control subjects
Assessed total healthcare costs 6 month prior to surgery and up to 5 years after surgery
Cost savings began accruing as early as 3 months after surgery
Total surgery costs were fully recovered
after 49 months for open procedures
after 25 months for laparoscopic procedures

16. Cost of Human Lives
Mortality rate is 4.5% per year without surgery compared to 1% per year after surgery
Only 1% of the eligible population is treated through bariatric surgery
About 25% of patients considering surgery are denied approval for surgery at least three times before obtaining approval
By then, 60% will report worsening health problems
Three of every 100 patients denied surgery will lose their lives in the next year due to deaths that could have otherwise have been prevented with surgery

17. Bariatric Surgery is SAFE!
In-Hospital mortality rate for bariatric surgery is now 0.1 %
Gallbladder surgery mortality 0.52 %
Hip replacement surgery mortality 0.93%

18. Denying Bariatric Surgery
Not cost effective
In the long-term, surgery is less costly
Patients in your state are being denied treatment that is widely available to approximately 45% of Americans
Consider that therapy for patients with other chronic diseases are not denied coverage
treatments are far more expensive and less effective in terms of remission of disease and decreasing disability and increasing productivity
Cancer treatments (medical and surgical)
Heart surgery

19. Obesity treatment coverage should be equitable for all Americans, including citizens who are beneficiaries covered through your State’s Health Insurance Exchange