By
Dan Vergano, Medical Tribune News Service
Despite
increasing rates of obesity among children, health insurers routinely
limit or deny coverage for children's weight-loss programs, according
to researchers.
More
than one in 10 children nationwide is obese, and the number of
obese children has doubled in the past two decades, according
to federal estimates. Compared with the typical child of their
sex and age, obese children weigh at least 45 percent more. Many
grow up to become obese adults, so they face a greater risk of
heart disease, diabetes and early death, according to the National
Heart, Lung, and Blood Institute in Bethesda, Md.
Researchers at the weight-loss program at Children's Hospital
of Philadelphia led by Dr. Andrew M. Tershakovec evaluated insurance
programs' support for young members' efforts to shed excess pounds.
Reviewing the cases of 191 children over two years, the researchers
looked at how a wide variety of insurers paid for their obesity
treatment.
The
researchers found that insurers covered only 11 percent of weight-loss
program costs, on average. More than one-third of the children
received no reimbursement at all for weight-loss treatment. The
researchers detected no difference in payments based on children's
race or gender.
Reimbursement
rates varied by insurance type. Blue Shield, a popular insurer,
paid nothing. Fee-for-service insurers, whose policies are among
the most expensive, paid 21 percent of the cost. Managed-care
companies paid the most, reimbursing 50 percent of program costs,
on average.
``That
fits in well with the managed-care philosophy of preventive care
being a first priority,'' said Susan Pisano, spokesperson for
the American Association of Health Plans in Washington, D.C.,
who added that health maintenance organizations know they can
save money by treating obese children before they turn into illness-plagued
-- and costly to insure -- adults.
At
Children's Hospital in Philadelphia, many patients opt out of
obesity treatment ``after they are told by insurers that the weight-management
program is not covered,'' the researchers noted. In one case they
described, of an 18-year-old with a body mass index of 53.8 --
more than twice the weight-to-height ratio of a healthy person
-- and sleep apnea, insurers refused coverage for evaluation of
the obesity that had triggered the sleeping disorder.
Parents
who decide to follow through with obesity programs for their children
end up paying out of their own pockets, leaving poor kids out
on the street, they added.
``It's
very discouraging news,'' said Barbara J. Moore, president of
ShapeUpAmerica! of Washington, D.C., a nonprofit organization
founded by a former surgeon general to educate people on the role
of fitness in a healthy lifestyle. She noted that children in
the Philadelphia program received top-notch treatment that included
dietary advice, a fitness plan and family counseling.
Some
of the blame for the poor reimbursement rates falls on the government,
said Moore, which she said has been tardy in delivering new weight
guidelines for children. In addition, she argued that organizations
like the American Academy of Pediatrics should promulgate standard
treatment guidelines for obese children.
The
researchers published their findings in the most recent edition
of The Journal of Pediatrics.
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