Joey Jarrard: Florida’s obesity crisis — time for Medicaid to act

kids feet on weight scale

Obesity is a chronic, progressive disease that affects one-third of adults in Florida.

We cannot afford to continue ignoring this health care epidemic, but unfortunately, for many people, comprehensive obesity treatment is difficult to access due to cost constraints and insufficient insurance coverage.

This is particularly challenging for our Medicaid population. Currently, there is no coverage for obesity medications or nutrition counseling and only limited coverage for metabolic and bariatric surgery and intensive behavioral therapy. It is quite perplexing that coverage for obesity treatment is so scant, given that 31.6% of Medicaid beneficiaries have obesity and another 12.2% have diabetes.

This lack of coverage highlights an outdated belief that obesity is the fault of an individual and can be eliminated through diet and lifestyle changes alone. Even though leading medical societies, like the American Medical Association, have recognized obesity as a disease for many years, policy and public perception have not caught up to the science.

The reality is obesity is more than a disease impacting a number on a scale. It is complex and progressive, influencing nearly every system in the body and compounding pre-existing conditions. Left untreated, obesity leads people to develop a range of other conditions such as prediabetes, type 2 diabetes, hypertension, high cholesterol, heart disease, stroke and cancer. Many of these conditions are chronic, requiring a person to need continuous care to manage the condition effectively.

Because of obesity’s complexities, providers must have flexibility in their treatment approach. Every patient presents their own unique set of circumstances. Some patients are not suitable candidates for bariatric surgery, which necessitates access to alternative options like nutrition counseling and obesity medication. On the other hand, some patients need a combined approach of drug therapy, surgery, and intensive behavioral health care. Regardless of the scenario, the fact remains that providers need every tool available to optimize a patient’s treatment plan and set them on a realistic path to recovery.

Many state and federal policymakers become swept up in conversations regarding the cost of covering obesity care and consequently pay little attention to the considerable health benefits to patients and significant long-term cost savings. That one-sided equation is unfair and rarely applied to treatments for other disease states.

As a physician who regularly works with Medicaid beneficiaries who have obesity, I know we are already paying a hefty price for obesity. We pay for it through emergency care, hospitalizations, and lost productivity. In fact, the STOP Obesity Alliance reports that the estimated medical cost of adult obesity in this country is roughly $147 billion per year.

In my own practice, I have treated patients who have been hospitalized for months due to obesity-related complications. Under normal circumstances, a patient who is too sick to be discharged home but not sick enough to warrant a lengthy hospital stay would be transferred to a rehabilitation facility to continue their treatment plan.

Unfortunately, because the patients I worked with had weights that superseded the rehab facility limitations, they were unable to be transferred to a lower acuity setting. What’s more, their acute medical condition (or the medical condition for which they were admitted) made bariatric surgery too dangerous to perform and, without coverage for other options like obesity medication, they were forced to remain in the hospital until they could be safely discharged.

Medicaid coverage for comprehensive obesity treatment could have avoided the costly scenario I described above.

With a lower weight, patients could have utilized the available rehab facilities, lowering the total health care spend for their care and freeing up hospital resources. If coverage were in place, these patients could have also begun a treatment regimen that would reduce their risk of obesity-related hospitalizations in the first place.

If we want to mitigate Florida’s obesity crisis, it is essential that we make access to comprehensive obesity treatment possible for patients. I am pleased to see lawmakers are already aligning with patients and providers on this issue. Sen. Ana Maria Rodriguez’s Senate Bill 648 and Rep. Fabián Basabe’s House Bill 713, otherwise known as the Diabetes Prevention and Obesity Treatment Act, would broaden Medicaid coverage policies for obesity treatment and diabetes prevention. These are timely pieces of legislation that I hope the entire Legislature will support.

Expanding coverage for comprehensive obesity treatment would undoubtedly result in better outcomes for patients and cost savings for the entire health care system. Healthier patients require fewer medical interventions, especially when conditions that create subsequent diseases and complications are treated early. But to make real, sustainable change, we need support from our elected officials who have the power to expand treatment access.

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Dr. Joey Jarrard is a board-certified, fellowship-trained, minimally invasive and bariatric surgeon specializing in advanced foregut surgery and bariatric surgical revisions. He is dedicated to providing comprehensive, patient-centered care and focusing on innovative surgical techniques, including robotic-assisted procedures. Dr. Jarrard serves as the Robotic Steering Committee Chair at Tallahassee Memorial HealthCare (TMH), where he plays a key role in advancing robotic surgery to enhance patient outcomes. In addition to his clinical practice, he is committed to surgical education as an Associate Professor with the Florida State University General Surgery Residency Program, mentoring the next generation of surgeons.