Insurers accused over 'killer' obesity

ABU DHABI // Insurance companies should recognise obesity as a disease and a "killer", and acknowledge doctors' suggestions for treatment, leading health specialists said yesterday.

Bariatric surgery - reducing the size of the stomach to achieve weight loss - is often recommended for obese patients with a body mass index (BMI) above 40.

Yet insurance companies have never approved bariatric surgery for patients in the UAE, and according to one major insurer, any change in the near future is unlikely.

"Even though the surgery has been proven as a treatment for patients, and even though obesity is ultimately a fatal disease, insurance companies do not see it that way and do not provide coverage," Dr Hayder al Zubaidy, chief executive of Canadian Specialist Hospital in Dubai, said.

This persistent view of bariatric surgery as a 'cosmetic' procedure showed that "healthcare providers and insurance companies are not working on the same page".

Dr al Zubaidy was speaking on the sidelines of the 6th annual Middle East Healthcare Innovation Summit hosted by the business information company Naseba and the Ministry of Health, a two-day event that opened in the capital yesterday.

Doctors at the conference presented the case that bariatric surgery was a viable treatment option for diabetic patients who suffered from obesity and who were not responding to medical or lifestyle interventions. Weight-loss surgery could even save money in the long run, Dr Khaled al Jabari, chief of endocrinology at Mafraq Hospital in Abu Dhabi, said.

"The cost-effectiveness of paying for a patient's bariatric surgery means not only saving that patient's life, but also saving costs on complications, hospital visits, treatments, medications and so on," he said.

Prof Safwan Taha, the medical director at Al Noor Hospital in Abu Dhabi, said that 85 per cent of patients who underwent bariatric surgery would benefit from a dramatic improvement in their blood sugar levels within six to 12 weeks.

"I believe that bariatric surgery, especially for diabetics, is changing the picture from a chronic, non-treatable illness to one that is treatable and no longer fatal," he said.

Dr al Jabari said he understood why insurance companies were reluctant to provide coverage for weight-loss surgery when so many patients and their doctors abused the procedure.

"Patients come in and tell me they want the surgery, as if it is up to them. These patients, who don't want to bother with diet or exercise and just want an easy way out, are not the ones we are talking about," he said.

Doctors want health regulators and authorities to develop criteria determining which patients are eligible for the surgery, and how they can be approved.

This would ensure that those who needed the surgery would benefit from it, Dr al Zubaidy said. "The goal of insurance should be patient safety. As with every disease in the world, we have policies and procedures to be followed, and this should be no different."

Before contemplating surgery, a patient should be diagnosed as obese, taking into account their BMI, and categorised according to risk factors.

After sessions with a psychiatrist, a dietician and endocrinologist, and recommendations that included medication, diet and exercise, the patient would be allowed a certain period of time in which to respond. If this did not work, surgery would be an option, said Dr al Zubaidy.

Insurance providers, however, said it was not up to them to decide which procedures to cover.

David Youssef, the regional managing director for NOW Health International, said that in insurance, anything could be covered for a cost.

"If something like bariatric surgery is not being covered, then there is a reason, which is that the consumer does not want to pay the price for full coverage insurance," he said.

The Abu Dhabi Government had ordered minimum coverage for all insurance policies, but to keep premiums affordable not all procedures were included, he said.

"Insurance companies have to be socially conscious, but they are not social benefit providers and still have to make money," said Mr Youssef, who has been an industry figure in Middle East insurance for the past 16 years.

With obesity, which he described as a lifestyle choice that was almost invariably self-inflicted, the situation was not unlike that of car insurance.

"You do not expect your insurance company to cover absolutely everything about your car, which has wear and tear, for example. You take care of it and take it for check-ups and give it maintenance," he said.

"Bariatric surgery can be covered by insurance, but it has to be built into policies at an extra cost, and right now, unfortunately, we live in a market where there is no consumer awareness on health insurance."

Dr al Zubaidy said that everybody would benefit if the cost effectiveness of weight-loss surgery was acknowledged.

"You save money by treating the patient's obesity, rather than waiting to treat the complications that will set in," he said.

And with the final complication of disease inevitably being death, said Dr al Zubaidy, there should be no argument.

He likened a patient with a BMI of 45 and above as a person with a noose around their neck.

"By not doing anything, we're just waiting for the chair to get kicked off to the side and for our patient to hang."

hkhalaf@thenational.ae