Some studies suggest obesity impacts brain volume and executive level functioning in cognition, which may or may not lead to a higher risk of dementia (including vascular dementia) and Alzheimer’s. Obesity may lead to several metabolic changes such as hypertension which may accelerate arterial aging and thus may impair cognitive function such as attention, executive function, and decision making. More research needs to be done here, and this article is not to say people with high BMIs have cognitive deficits because they don’t. In fact, treatment of obesity may improve cognitive function. In randomized, double-blind studies,8 elderly patients with MCI and obesity showed improved verbal memory, verbal fluency, executive function, and global cognition after a calorie restricted diet alone.
During the COVID‑19 pandemic, many countries reported those quarantined were more likely to show signs of depression, panic, and anxiety symptomatology. Further, many also reported average weight gain in individuals to be between 25‑30 pounds.
Research and medical advancement on the obesity front is accelerating faster than ever before. Claims professionals should understand the complexity obesity presents, treatment advances, and corresponding challenges.
Some treatment regimens require surgical interventions like the lap band (e.g., putting a rubber band around your stomach to shrink its intake) and gastric bypass/gastric sleeve (e.g., where part of the stomach is cut, and intestines rerouted), and are not in and of themselves permanent solutions to the causation of obesity. If the underlying cause is not treated, the surgical intervention may only offer temporary relief.
While weight loss medications don’t come without potential side effects, the risk and potential complications associated with more interventional options such as bariatric surgery are significant. If treatment with injectables like Mounjaro (not yet widely approved or endorsed) and Semaglutide continue to offer similar results in non-invasive approaches, demand for weight loss surgery may significantly decrease. This is important for claims resources to understand. When assessing one’s occupation in a case, there’s need to understand what’s driving the loss of income (e.g., due to an impairment or extenuating circumstance such as demand for service drying up).
Since the world of bariatric treatment is ever-changing, it’s important for claims professionals to understand the advancements. For example, gene research is suggestive that even applying all appropriate treatment measures, one can still be obese. If one can achieve an overall 10% weight reduction, it can have immediate positive impacts on one’s ability to function, and more significantly engage in less invasive lifestyle changes to improve overall health and even reduce A1C levels, to mention a few.
Some of the drawbacks are the speed in which the weight loss occurs and the consequences of rapid weight loss on other organs (e.g., gall bladder, liver, etc.) and the excess skin, skin flaps and infections (e.g., yeast, staph, etc.) that may come into play or reduce one’s perception and ability of increasing activity. Use of stimulants (e.g., Adderall XR), appetite suppressants such as phentermine are other options being relied upon by some as an attempt at weight management.
Another important aspect for claims professionals to understand in the treatment of obesity is whether there are comorbid factors involved and if the patient is being treated in a multidisciplinary approach. Prior to undertaking any surgical intervention, a thorough work‑up including a mental health assessment typically occurs. Most treatment begins with conservative approaches versus leaping into invasive treatments.
Extra risks with comorbidities?
Some of the issues often experienced in obese individuals include both physical and mental health conditions. In some, isolation may lead to depression and anxiety. Treatment in these extreme cases may include simple baby steps. For example, orienting individuals to focus on getting out of the house even for noticeably short periods of time, such as going to the mailbox. For those where weight is manageable, increasing activity and healthy nutrition is often a journey begun with a multidisciplinary team: nutritionist, bariatric provider, psychologist, and even a sports medicine provider. As a claims professional, understanding who makes up the multidisciplinary team is important but more important is who is coordinating the overall care. Each of these providers may have a treatment regimen for the individual – but how it all comes together is key.
Body shape is also of importance when one thinks about managing obesity in a comorbid fashion. Understanding if a body shape is pear, oval, or round, and where the bulk of the weight is carried, has much meaning. If the weight is carried all around the waist and upper body, this may put more strain on the heart. If pear shaped, most of the weight tends to be around the hips and lower part of the body. This is suggestive of potential issues with the joints to carry the body. One of the conservative approaches on pear-shaped bodies is to ensure the feet can carry the weight. Proper footwear is important and may help to take some of the pressure off the joints. Again here, a 10% drop in overall body weight may also alleviate some of the pressure on the joints especially if one’s occupation involves prolonged periods of standing, walking, or traveling. Many having knee replacements are encouraged to try out HOKA sneakers.
Dr. Casey Kerrigan, founder of OESH shoes, spent years researching gait and the effects of footwear on the body. Pain clinicians know the obstacles faced by individuals with chronic pain and obesity. They realize in some instances how hard it is to move, that exercise may flare pain (perceived or realized), and that they may not make the best food choices. We know, however, pain that occurs with obesity is not exclusively mechanical.
Comorbid obesity and pain conditions may be related to subtle processes that start early in life, including genetics, environmental stress, and even potential trauma. Cultural and familial coping patterns, maladaptive coping and autonomic dysfunction can also influence motivation and behavior. We know depression may magnify comorbid physical symptoms and complicate treatment.
Obesity – Physical and Mental Health Comorbidities