Do Medical Aids Cover Obesity Treatment?

Obesity is a global problem and it’s growing. It’s no longer just associated with wealthier countries and statistics reveal that it’s doubled since 1980.

Obesity TreatmentAccording to the World Health Organisation, there are more than 2.8 million deaths annually around the world because of obesity or being overweight.

In South Africa, Profmed Medical Scheme claims that 61% of the population is overweight or obese but to compound the matter further, 78% of obese and 52% of morbidly obese people regard their weight as normal.

The definition of overweight or obese is that a person has an abnormal or excessive accumulation of fat that can have a negative effect on their health. A common but not entirely accurate measure of weight is achieved using a statistical measuring device called a Body Mass Index or BMI. It uses a person’s weight and height to work out average weight ranges among adults. Someone is considered overweight if their BMI is equal to or greater than 25, they are obese if it’s equal to or more than 30 and a BMI over 40 is considered morbidly obese.

Obesity can also be calculated using the circumference of the waist.

Experts around the world have acknowledged the complicated nature of obesity but they’ve also distinguished several contributing factors.

Essentially a person consumes more calories than they expend. Diets have changed and more energy-dense foods, high in fat, are being eaten. This is combined with humans leading more sedentary lifestyles because jobs require them to sit, rather than engage in manual labour, and improved transport means people no longer walk around as much as they used to.

Someone who is overweight or obese is at a greater chance of developing chronic diseases like Type 2 diabetes, high blood pressure, high cholesterol, heart disease, cancer and asthma.

Obesity is recognised as a major health problem, but many medical schemes have historically considered weight loss surgery a cosmetic procedure and have not covered the costs. However, South African medical schemes are increasingly starting to pay for all or part of weight loss surgery but only if a doctor has established that it’s medically necessary to preserve the health of the medical scheme member. The cost of bariatric surgery is expensive and if it is covered what’s often excluded is the plastic surgery to remove excess skin after weight loss, diet counselling and the required vitamins and supplements.

Discovery Health was one of the first medical schemes that covered bariatric surgery but only on the Executive and Comprehensive Plans and preauthorisation was required. Bonitas covers the surgery if a member is morbidly obese but it’s also subject to preauthorisation. Other medical schemes that cover the surgery include Momentum Health, Medshield and Metropolitan Health but it’s essential to check with your specific medical scheme.

Being overweight or obese is largely preventable but it involves a complete lifestyle change, which can be challenging. A person needs to make healthier food choices and engage in regular physical activity. When this isn’t enough, that person may require weight loss surgery to help them achieve a healthy weight.