Obesity is a disease: Does that change the way doctors practice?

Recently, someone asked me on Twitter, “Has the change in classification of obesity as a disease affected how you treat patients presenting w/ the disease?”

The classification change in question is regarding the American Medical Association’s declaration that obesity is a disease rather than a comorbidity factor.

This change in classification affected 78 million American adults and 12 million children. The new status for obesity means that this is now considered a medical condition that requires treatment. In fact, a recent Duke University/RTI International/Centers for Disease Control and Prevention study estimates 42% of U.S. adults will become obese by 2030.

Obesity is already a substantial public health crisis in the United States, and internationally, with the prevalence increasing rapidly in numerous industrialized nations. In 2009-2010, the prevalence of obesity among American men and women was almost 36%.

According to a 2012 Gallup Poll, 3.6% of Americans were morbidly obese in 2012.

The decision to reclassify obesity gives doctors a greater obligation to discuss with patients their weight problem.

And, as the blog Insurance Thought Leadership points out, “It’s … enabling [doctors] to get reimbursed to do so.”

According to the Duke University study, obesity increases the healing times of fractures, strains and sprains, and complicates surgery.

According to another Duke University study that looked at the records for work-related injuries:

  • Obese workers filed twice as many comp claims.
  • Obese workers had seven times higher medical costs.
  • Obese workers lost 13 times more days of work.

The U.S. Department of Health and Human Services said the costs to U.S. businesses related to obesity exceed $13 billion each year.

Prior to June 16, 2013, the ICD code for comorbidity factors for obesity in workers’ was ICD-9 code 278. This is related to obesity-related medical complications, as opposed to the condition of obesity. Now there are new ICD codes to indicate a disease, or condition of obesity which needs to be medically addressed.

Careful, here. Insurance will in fact pay primary care doctors to tell you, you are obese.

They will even pay doctors to address this existing obesity.

However, insurance will not pay me as a doctor to sit with you for 30 minutes to talk about how obesity might be a problem for you in the future.

They will not pay me to educate you on how to prevent it, and what will happen if you don’t.

Also, if you’re at risk for high blood pressure, obesity, or cholesterol issues, but don’t quite meet diagnostic/insurance criteria for that specific diagnosis, then I won’t even get paid for our visit (unless I fudge the number, or provide alternate ICD coding).

It’s worth pointing out, because I can hear the critics already chiming in, “But my doctor spent an hour last week with me talking to me about how to prevent type 2 diabetes.”

And I’m going to say that is a real good doctor we’re talking about, and you should know you’re blessed.

However, I’m going to take a minute to call out that that doctor was wedged into an insurance deception in order to collect reimbursement for that time.

Alternatively, that doctor might have just done you one solid, and treated you for “free.”

Check out this example of what happens when doctors insist on spending “quality time” with their patients.

However, most doctors learn to not talk about anything unless they can associate with a clear diagnosis that meets insurance criteria. In fact, this mechanism of our medical system is difficult to talk about. That might be why we needed a documentary to do it for us. Seriously, who wants to admit that in order to succeed at your life ambition, to help people, you’d have to forgo the very virtues that led you there?

Critics will say, but the system we have works. We insure people, keep them protected, and then we dole out primary care on an as-needed basis. And in many cases, that’s fine. Fine being the key word. It’s what we’re used to.

But are you fine being the 37th most effective health care system in the world?

I’m not.

And where are we failing?

For starters, heart disease. It’s our number one cause of death in the U.S. And it’s a condition with strong correlation to obesity.

However, insurance will not pay me to talk about weight loss.

In my experience, it’s no simple task to give patients the right information and get them to apply it.

Given that history of failure, I can see why the insurance doesn’t want to pay for it. They don’t see a return on investment.

I’d argue that this is because you can’t break health and prevention down to a specific visit. It’s a process that requires ongoing time to work with patients on their issues–weight, blood pressure, smoking, stress, etc.

So, to answer the question: No, I didn’t change how I practice because obesity is now a disease.

Instead my goal has been to change how we deal with preventable diseases.

I have patients paying me a reasonable fees who get all of my effort and attention. That includes preventative treatment. They themselves are investing in their future now. Meaning if I fail to make a difference, that’s on me. Both as a practitioner, and a thinker.

But it’s also on them. If they aren’t taking my advice, then it begs the question: “Why are they paying me?”

Insurance is not set up to do much more than window service on preventative care. Not out of ill-will, but because it’s literally structured to diagnose existing problems.

Insurance can only react, and distribute payment in relation to existing problems. Not the problem that was prevented.

And that right there, is the real problem.

Josh Umbehr is founder, Atlas.md.

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