Obesity epidemic shows perils to health reform

By Debra Sherman

CHICAGO (Reuters) - For years, Bob Clegg's insurance company paid out some $3,000 a month for doctor visits, drugs and medical devices to treat the health problems caused by his obesity.

In September 2007, when his weight peaked at 380 pounds (172 kg), he had gastric bypass surgery, and now his health issues -- joint pain, sleep apnea and esophageal problems -- have vanished, and so have the medical bills.

But even though the surgery -- in which the stomach is made smaller and part of the intestine is bypassed -- has saved his insurance company money, Clegg, who now weighs 240 pounds (108 kg), had to pay the $20,000 cost out of his own pocket.

"It wasn't until the doctor said my sleep apnea was at a point where we seriously had to consider a tracheotomy that we talked about gastric bypass," said Clegg, 54. "The irony is that insurance would pay for the tracheotomy, but not the surgery."

Clegg's experience highlights the difficulties facing the United States as it confronts an epidemic of obesity, and the problems for President Barack Obama as he sets about extending health insurance to more Americans at a time of runaway costs.

While his experience is typical, unlike most other people, Clegg was in a position to make some changes.

As a member of New Hampshire's senate, he took what he knew about obesity and the cost of treating related chronic illnesses to the state capitol, where he introduced a bill in January 2008 requiring insurers to offer surgery as a treatment option, just as the state's Medicaid program for the poor does.

While other states -- some of which don't cover any obesity treatment -- are studying New Hampshire's approach, experts say economics will increasingly drive policy at a time of burgeoning budget deficits.

EPIDEMIC COSTS

About two-thirds of American adults are overweight or obese, putting them at an increased risk for diabetes, hypertension, heart disease, osteoarthritis, stroke, gallbladder disease, sleep apnea and respiratory problems and even some cancers.

The direct and indirect costs of obesity is $117 billion each year, according to a 2000 report by the U.S. Surgeon General.

Christine Ferguson, associate professor at George Washington University School of Public Health and the director of STOP Obesity Alliance, said the stigma surrounding obesity and belief that it is not a disease are keeping the government from addressing the crisis.

"At the root of this is that people still have a real problem thinking about obesity as anything other than a willpower issue," said Ferguson. "It is still perfectly acceptable to think about excluding treatment."

Ferguson, who has held high level healthcare posts in Massachusetts and Rhode Island, acknowledged the difficulty in changing the way government thinks about spending on obesity.

"If I have to balance my budget at the end of each year, I have a choice between investing money in children who have mental retardation, or children with developmental disabilities ... or investing in people who have obesity, choosing obesity is a very hard case to make," she said.