Obesity coverage gap: Consumers perceive low coverage for obesity treatments even when workplace wellness programs target BMI


  • Funding agencies: This work was funded by the Obesity Action Coalition.

  • Disclosure: TKK has received consulting fees from 3D Communications, Novo Nordisk, EnteroMedics, and Eisai, outside this work. FCS is on the Speaker's Bureau for the American Academy of Nutrition and Dietetics and serves as a content editor for EBSCO/DynaMed. ERW declared no conflict of interest.

  • Author contributions: TKK and JFN conceived and designed the survey and performed data collection. ERW wrote the manuscript and performed the statistical analysis. ERW, TKK, and FCS analyzed the data. ERW, TKK, and FCS were involved in writing and reviewing the paper. All authors had final approval of the submitted and published versions.



Evidence-based obesity treatments, such as bariatric surgery, are not considered essential health benefits under the Affordable Care Act. Employer-sponsored wellness programs with incentives based on biometric outcomes are allowed and often used despite mixed evidence regarding their effectiveness. This study examines consumers' perceptions of their coverage for obesity treatments and exposure to workplace wellness programs.


A total of 7,378 participants completed an online survey during 2015–2016. Respondents answered questions regarding their health coverage for seven medical services and exposure to employer wellness programs that target weight or body mass index (BMI). Using χ2 tests, associations between perceptions of exposure to employer wellness programs and coverage for medical services were examined. Differences between survey years were also assessed.


Most respondents reported they did not have health coverage for obesity treatments, but more of the respondents with employer wellness programs reported having coverage. Neither the perception of coverage for obesity treatments nor exposure to wellness programs increased between 2015 and 2016.


Even when consumers have exposure to employer wellness programs that target BMI, their health insurance often excludes obesity treatments. Given the clinical and cost-effectiveness of such treatments, reducing that coverage gap may mitigate obesity's individual- and population-level effects.