Table 5.

Key points for use when advocating for the reimbursement of childhood obesity treatment with payers.

	Key Advocacy Points
Efficacy	Scientific evidence exists supporting the efficacy of treatment for childhood obesity. Biomedical and psychosocial improvements in the child and immediate family reduce the likelihood of comorbidities. If applied on a population level, there is potential for a significant impact on the public health of children and parents.
Patient-Related Variables	This treatment would be valued by families and could boost enrollment since childhood obesity is a top health concern for parents. Patient-reported outcomes have been found, including improvements in: Physical functioning, quality of life, self-esteem, depression, academic performance, and important cognitive skills like executive function.
Return on Investment	Childhood obesity incurs direct medical costs that include, but are not limited to: emergency department visits, prescription medications, and medical specialty care. Reimbursing for childhood obesity treatment thus presents an opportunity to invest in treatment potentially leading to lower lifetime medical costs. Costs of childhood obesity treatment may be offset in adulthood through the prevention of obesity-related comorbidities like heart disease and diabetes. Positive weight outcomes extend to the caregivers, siblings, and community. Children could experience fewer school absences, resulting in academic improvements, thus providing the country with a more prepared work force. Adults could reduce absenteeism and presenteeism thereby creating a more productive work force and reduce productivity-related costs due to fewer child sick days.
Mandate	The American Medical Association has designated obesity as a disease, and as such, medical necessity will arise for those children and adolescents suffering from severe obesity with co-morbid physical and mental health conditions. The USPSTF have endorsed moderate to high intensity, multicomponent, behavioral interventions for the treatment of childhood obesity with a grade B recommendation. The ACA has specifically stated that all services designated with a grade A or B from USPSTF MUST be covered without copayment. Therefore, childhood obesity treatment services consistent with USPSTF recommendations must be covered by private insurers. EPSDT amendments establish new coverage requirements under Medicaid, to cover “early and periodic” screening and diagnostic services to ascertain “defects” and “chronic conditions” in children, as well as healthcare and treatment needed to “correct or ameliorate” such defects and conditions discovered during the screening examinations (see Supplement 4). The EPSDT benefit bars limitations and exclusions used by commercial insurers to exclude otherwise-covered treatments that promote the health of children with serious physical and mental health conditions that delay development.

USPSTF = United States Preventive Services Task Force; EPSDT = Early and Periodic Screening, Diagnostic and Treatment