Food Addicts' Dilemma


The consequences of being morbidly obese are well known. As body mass index (BMI) goes into the very obese range (greater than 45), life expectancy falls. Just how much younger you die depends on many factors, with age, race and how long someone has been obese just a few.

Still, insurance companies and other third party payers have to pick some BMI number. They have to decide at what number they will pay for treatment. The treatment under consideration is bariatric surgery, with the most popular type being gastric bypass surgery.

The dilemma for food addicts is whether to eat more to qualify. By eating more – in effect yielding to their addiction – they can gain enough weight to meet the criteria and get the surgery. An example, from an NBC article explains the choice. The subject, an obese woman in her 30’s, was 5 foot 6 and 202 pounds. This gives a BMI of 32.

At a BMI of 32, someone is considered obese, but not obese enough to warrant bariatric surgery. Insurance companies may set the bar as high as 45, meaning our example patient would need to weigh about 280 pounds. In this case, she’d need to add 80 pounds to qualify, and at a cost of about $20,000 for the operation, this may be the only realistic choice.

While these numbers represent a fictitious case (the patient mentioned above was able to get into a medical trial instead) the choice is real. It amounts to someone having to make their problem worse so they can get treatment.

Thankfully, the landscape is changing. If there is another medical problem, such as diabetes or high blood pressure, the procedure can be done at a lower BMI, at least according to changes at the FDA. Insurance companies are not bound by these recommendations though and benefits do not always follow directly from a regulatory change.


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