The Struggle is Real!

By Dr. Charlotte Hodges

The Obesity Action Collation (OAC) is a non-profit organization of nearly 60,000 members. Their mission is “to elevate and empower those affected by obesity through education, advocacy and support.” The core focus of the organization is to:

• raise awareness and improve access to the prevention and treatment of obesity
• provide evidence-based education on obesity and its treatments
• fight to eliminate weight bias and discrimination
• elevate the conversation of weight and its impact on health
• offer a community of support for the individual affected

The organization was formed in 2005 after the need for advocacy for patients affected with obesity arose in the legislature.
As a member of the American Society of Metabolic and Bariatric Surgery (ASMBS) and surgeon who works with insurance companies on a daily basis, I know first-hand the struggles that patients can have to access to care. I was very pleased to hear that OAC along with the AMA were able to bring a very strong voice to congress to affect change. I recently received an updated briefing about a reduction in pre-operative medical management for Cigna policy holders. As of January 1, Cigna policy holders no longer have a 90 day supervised diet. Prior to this policy change, a patient had to undergo a 90 day diet prior to a pre-authorization for bariatric surgery. As a clinician, I have not seen a difference in long term or short term outcomes between patients who have to undergo pre-operative diet/weight management programs versus those who do not. This is regardless of the time spent in these programs. Some insurance providers require a 6 month program up to a year. ASMBS has done much research in this area and agrees. They too have an official policy stating how this is seen as more of a barrier to entry rather than providing better outcomes. (Most programs require the patient to meet for a specific time over consecutive months. If you miss a month, the clock starts over. So, if you have a 90 day diet which you begin in September, you cannot even submit a request for prior authorization until December, after your last diet visit. And, if you miss month, FOR ANY REASON, the clocks starts over. The patient will have to wait until the next year for surgery. The deductible starts over, and they risk changes to their policy that could reduce or even remove bariatric coverage all together).

When I received the update for Cigna, I was overjoyed and excited to share the news with my patients! So, how do we work to increase bariatric coverage for all of our patients? It’s through advocacy. The OAC, Obesity Medicine Association (OBA), and ASMBS have been lobbying our local and state medical societies as well as the AMA on our patient’s behalf.
On June 12, 2018, the AMA accepted a policy drafted by the Obesity Medical Association, “Removing Barriers to Obesity Treatment.” The OMA was able to garner support for this measure from AMA Colorado delegation, the Minority Affairs Section, the American Association of Clinical Endocrinologists, American Society for Metabolic and Bariatric Surgery, the Endocrine Society, American College of Surgeons, and the American Gastroenterological Association. The statement reads, “AMA work with state and specialty societies to identify states in which physicians are restricted from providing the current standard of care with regards to obesity treatment… and that AMA actively lobby with state medical societies and other interested stakeholders to remove out-of-date restrictions at the state and federal level prohibiting healthcare providers from providing the current standard of care to patients affected by obesity.”

Additionally, National Lieutenant Governors Association (NLGA) passed a policy resolution during its June 27-29, 2018 Annual Meeting. The resolution, which was introduced by Lieutenant Governors Fairfax (D-VA), Gregg (R-IA), Nungesser (R-LA), Wyman (D-CT) and Zuckerman (D-VT) will help: reduce obesity stigma; establish statewide obesity councils and taskforces; support additional training for current and future healthcare professionals; and support access to obesity treatment options for state employees and in other publicly funded healthcare programs.

If you are struggling with your weight, a current or future bariatric patient, or have a family or friend in the bariatric community, I encourage you to join OAC. It is free to join, and I’m looking into how I can, as a provider, better support the work that they do.

Located on the OAC website, patients denied access can learn more about their insurance policy, contacting elected officials, working with their employer, and much more to help them improve access to obesity treatment! Learn more today by visiting

2. Medtronic Obesity & Metabolic Health Solutions Bulletin, January 2019


Bariatric Support Group

Dr. Hodges highly recommends patients attend monthly support group meetings. The meetings are led by Dr. Collins Hodges, both a licensed clinical psychologist and someone who has had bariatric surgery himself. The support groups are offered on the first Monday of every month from 6:30pm – 7:15pm CST via an online GoToMeeting. The meetings are open to the public, and there is no charge to attend.

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