Using a Whole-Health Approach to Managing Obesity
Weight gain doesn’t happen overnight — or even quickly for that matter. Sometimes weight is gained so gradually that people don’t realize they have reached a severely unhealthy weight until something happens with their health to bring it to their attention.
Over the past two decades, the percentage of people age 20 and older in the United States whose weight to height ratio reached the classification of obese, increased from 30% to 42%. For many people who realize it’s time to do something about their weight, the first thought is to find a procedure or pill that can help them lose weight quickly.
“Unfortunately, there is no quick fix to losing weight and finding a weight management plan that works for every person,” said Dr. Shantanu Agrawal, chief health officer at Elevance Health. “Maintaining a healthy weight requires a long-term, if not a lifetime, commitment.”
Understanding What Causes People to Gain Weight
The reasons people gain weight are as varied and unique as they are. For some, it can be caused by not watching their portion sizes, choosing highly processed foods, and consuming high-calorie, low-nutrient drinks; genetics can also play a role, as well as experiencing stress and anxiety. There are cultures and communities with a high focus on food, which can result in people overeating to maintain cultural traditions and norms.
Certain physiological processes, hormone imbalances, or medications can make it harder for some people to stay at a healthier weight even if they eat nutritious foods and exercise regularly.
Sometimes food is used as a method to avoid feeling emotions, especially related to a physical, mental, and/or emotional trauma. People may use extra weight as a barrier, providing themselves with a feeling of safety and control that was lost through earlier traumas.
“It’s imperative we understand the various social and behavioral experiences of each person,” Agrawal said. “If a person doesn’t have regular access to nutritious food or uses food to manage emotional stressors, those factors will play a key role in establishing a successful health improvement plan.”
Getting Started With Digital Tools
Elevance Health’s commercial health plan affiliates provide access to Sydney, a health app that gives members to the ability to use health tools and see their health coverage information. Members can take a health assessment that considers all the drivers of health—physical, behavioral, and social—and helps the health plan offer members programs that might interest them.
“We have several programs that are designed around making healthy choices to help prevent diabetes,” Agrawal said.
Several times per year, members are prompted by email to use Sydney to check in on their health goals. They can choose from a variety of action plans that help them increase their activity, manage stress, and track their nutrition. Sydney can be connected to a member’s fitness tracker or watch so they can log their time and activity to track results.
Some Elevance Health commercial plans also offer a weight management program called Well-being Coach. In this program, the member consults with a team of health educators and registered dieticians and in some cases, a pharmacist to help them safely guide their weight loss journey.
Counseling Can Create Pathways to Success
Behavioral counseling can be helpful to people on their weight loss journey to better understand what may be contributing to their condition. Addressing these factors will help people find success in maintaining a healthier weight long-term.
Therapy can also provide a safe and effective approach to address the underlying issues that may lead to obesity and associated health conditions. High blood pressure, certain types of cancer, joint pain, arthritis, sleep disorders, and diabetes are all conditions that may result from weight gain. Each of these additional conditions can increase stress levels, which could lead to additional weight gain instead of loss.
Behavioral therapy has proven successful for people working to lose excess weight and maintain a healthier weight. Following up with nutritional counseling can help solidify behavioral shifts and changes from a short-term intervention to long-term effectiveness. Our health plan affiliates provide coverage for behavioral therapy and nutritional counseling.
Considering Other Treatment Options
Medications are another tool to support those managing obesity. They typically are approved only for short-term use in an effort to jump-start weight loss, demonstrating progress that may maintain motivation to continue long-term loss and healthier weight management.
Certain medicines, like phentermine, can be taken for up to 12 weeks while monitored by a health professional. Not everyone who starts on medication will complete the therapeutic regimen. For many, without the proper behavioral and lifestyle changes in place, weight loss turns to weight gain after the medicines are stopped.
Surgery may be an option for people with severe obesity who would benefit from more intensive treatment. People seeking these surgeries must meet very specific criteria to establish medical necessity.
Bariatric surgery options range from reversable procedures like lapbands and gastric balloons to permanent procedures like gastric sleeves and gastric bypass, where large portions of the stomach are removed. These procedures physically limit the amount of food people can eat throughout their life, but they do not address any behavioral and social drivers of health.
Insurance coverage for surgical procedures and medications varies depending on state regulations, what employers offer under self-funded plans, and individual case review.
Prioritizing Safe, Effective, and Individualized Treatment
“Any medical intervention for obesity should be treated not as a panacea but as one tool used as part of a whole-health treatment plan,” Agrawal said. “Their effectiveness must be evaluated carefully along with their risks.” Prioritizing safety sometimes means not using popular new medicines or treatment.
Treating obesity includes more than losing 30, 40, or 50 pounds. It takes a concerted, long-term effort to manage the factors that led to weight gain and to embrace a lifestyle that will support a healthier weight.
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