National Reports-The debate on whether or not to declare obesity a disease has health plans looking deeper at wellness programs for diseases and conditions that can be prevented, improved or have their progression delayed through lifestyle modification.

"Wellness programs, for example, could prompt increased activity and improved dietary intake for those who are moderately overweight," Jonathan T. Lord, MD, senior vice president and chief innovation officer for Humana, told MHE. "As more alternative treatments are developed that are less risky, less expensive and potentially more effective, the issue around coverage of surgery for the morbidly obese may not be as controversial."

Through its coronary artery disease and diabetes management programs, Humana plan members are encouraged to increase their exercise, improve their diets and lose weight. Humana currently is reviewing a health and wellness program that includes a health risk assessment to reach out to members who are overweight and provide them with program offerings to address increased activity and weight loss.

Within its own employee population, Humana has developed a "Shape It Up for Better Health" program to encourage increased activity and weight loss. "Employee response has been good and it is our goal to increase participation in the program," Lord says.

Many diseases and conditions for which people are treated have some balance of lifestyle and genetic components, according to Lord. "For example, if you have heart disease, it is important to reduce the sodium and fat in your diet," he says. "Obesity does contribute to other health problems-heart disease, high cholesterol, and high blood pressure. Encouraging individuals to engage in healthy behaviors to reduce the incidence of obesity could positively impact the overall health of our population and, in turn, reduce the consumption of healthcare resources. This will have to be a societal effort as well as an individual effort."

Health plans need to continue to invest in and reinforce opportunities for prevention education and serious individual lifestyle incentives vs. gimmicky "value-added" tactics, according to Deborah D. Stephens, principal consultant, DD Stephens & Associates, a healthcare and benefit marketing consulting company in Jacksonville, Fla.

"Most plans have implemented wellness programs, but need to take the element of depression and psychological benefits more seriously and work with behaviorists to enhance accessibility to those services," Stephens notes. "They need to support their providers, work with consumers, employers, brokers, vendors and appropriate government agencies to effect change as partners against obesity."

Coverage considerations

Another important point in this debate is that coverage of weight-loss drugs should not be seen as the only tool to address this problem, Lord says. "The medical data shows safety concerns associated with these medications after prolonged use. Once individuals go off the medications, weight will likely come back," he says.

With regard to diet drugs, Humana coverage varies depending on the type of pharmacy benefit an employer has. Under Humana's Rx4 and RxAllowance pharmacy benefits, there is some discounted or limited coverage. "Our Rx3 model does not have coverage for these medications," Lord says.