The freshman 15 is now the COVID 19…pounds, that is. While humor surrounding unintended weight gain has circulated for decades, the pandemic has intensified what we already know: America’s population is getting larger, and the negative impact on health outcomes and medical costs can no longer be ignored.
But a look at claims data gives an incomplete picture. While the National Health and Nutrition Examination Survey indicates that more than two-thirds of working age adults (20 to 74 years) have overweight or obesity, coding for the disease is much lower in claims data.1 In fact, a recent analysis by the Midwest Health Initiative (MHI) showed an obesity coding rate of only 8.3% among commercially insured patients in Missouri.2 2021 research by Milliman suggests that the portion of commercially insured populations with an obesity diagnosis may be up to three times higher than evidenced in claims data.1
Obesity Class Category | Body Mass Index (BMI) | ICD-10 Codes |
Class I | 30.0 - 34.9 kg/m2 | Z68.30 through Z68.34 |
Class II | 35.0 - 39.9 kg/m2 | Z68.35 through Z68.39 |
Class III | Greater than 40.0 kg/m2 | Z68.41 through Z68.45 |
Beyond the importance of obesity class and BMI coding for diagnosis, these measures are also meaningful for assessing the incidence of comorbid conditions like cancer, type 2 diabetes, heart disease, and osteoarthritis. Taken together, these and other obesity-related illnesses amount to over $209 billion in medical costs per year in the US, or an additional $1,900 per person with obesity per year. Add in indirect costs related to absenteeism and productivity losses, ranging from $5,515 to $9,104 per employee with overweight or obesity, and the economic impact of this chronic disease becomes clear.2
For self-insured employers and other payers, this gap in coding can present a challenge when trying to understand the opportunity for action. Facing unsustainable increases in health care expenses, many organizations are considering how benefit and well-being offerings can prevent and treat excess weight among employees.
A leading academic and clinical research institution, Washington University in St. Louis, offers a story of success in using a holistic approach to promote healthy minds and bodies across their workforce. Senior Manager for Wellness and Benefits Projects, Emily Page, aims to leverage both in-house and external partners to meet employee needs. “Our team of registered dietitians, a mindfulness consultant, registered nurse, and health promotion professionals brings expertise across a wide spectrum of wellness topics. We collaborate with University experts and community partners to offer evidence-based programs where employees can assess their current health status, engage in year-round health education programs, set goals for improving health decision-making, and track progress.”
To support sustainable, healthy weight loss, the wellness initiative partners with obesity expert, Dr. Denise Wilfley, Director of the Center for Healthy Weight and Wellness in the School of Medicine, to offer MyWay to a Healthy Weight, a 12-month, intensive weight management program with a holistic focus on employee well-being. In the first phase, the in-house team of registered dietitians and behavior change consultants meet with participants weekly for three months to personalize their weight loss strategy. The second phase of the program engages participants in small group discussions, while monthly “booster” sessions and periodic email communications in the third phase help employees to stay on track. Initial outcomes have been positive in the program’s first year, with participants averaging 8% weight loss over a 12-month period.
While well-being programs focused on diet and exercise may be sufficient for some employees to shed the pounds, others may require additional support to meet the AACE/ACE target of 5% to 15% weight loss and see measurable improvements in A1C, blood pressure, and comorbid conditions.3 In addition to lifestyle therapy, employers may choose to cover anti-obesity medications, non-surgical weight loss procedures, or bariatric surgery as part of their benefits design strategy.
From a clinical perspective, Dr. Susan Reeds, an internal medicine physician and Director of the Medical Weight Management Program at Washington University in St. Louis, has seen positive outcomes in patients using pharmaceuticals to lose weight. “Anti-obesity medications are an integral part of the comprehensive treatment plan for many of my patients,” she noted. “Analysis of data from an employer-sponsored weight management initiative based in our clinic suggested that earlier initiation of medications, specifically GLP-1 receptor agonists, may increase the likelihood of achieving clinically significant weight loss.”
The toolbox for treating obesity is expanding, and accurate and timely diagnosis is the key to getting people the right intervention at the right time and monitoring progress. But we won’t get there until coding of overweight and obesity becomes a standard practice in the medical field. Only then will we understand the true impact of this costly chronic disease and the opportunity to do more…as providers, payers, patients, and the community at large.
The Midwest Health Initiative thanks Champion for Health Care Value, Novo Nordisk, Inc., for contributions to this article and ongoing support of MHI's community work.
Milliman. (2021). Obesity in a Claims-Based Analysis of the Commercially Insured. Prevalence, Cost, and the Influence of Obesity Services and Anti-Obesity Medication Coverage on Health Expenditures
Midwest Health Initiative. (2022). Obesity Trends Analysis among Commercially Insured in Missouri.
American Association of Clinical Endocrinologists and American College of Endocrinology. (2016). Comprehensive Clinical Practice Guidelines for Medical Care of Patients with Obesity.
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