Español Obesity is so common in the United States that nearly half (4 out of 10) American adults live with the disease, which can pose serious health risks and lead to premature death. Many people living with obesity face discrimination or poor treatment in the workplace. Employers can help reduce stigma, improve working environments for people with obesity, and make sure employee benefits cover medically necessary treatments and programs. Covering treatments for obesity can not only improve the health and well-being of employees, but it can also reduce company healthcare costs. Employees can also play a role by advocating for their needs and for a workplace built on fairness, compassion and respect. Here’s how to address obesity and related health insurance coverage in the workplace: EmployersHow to talk about obesity Do say: People living with obesity. Don’t say: Obese people, fat people or overweight people.How to think about obesity Do recognize that obesity is a disease, not a character flaw or lifestyle choice. Don’t assume that workers living with obesity are unmotivated or unprofessional.Do recognize that, for some people, diet and exercise are not enough to lose weight. Medications or surgery may be necessary. How to communicate with employees living with obesity Do be respectful, compassionate and open. Don’t dismiss people’s concerns.Don’t judge or mock people’s experiences or appearance.What you can do to support people living with obesity Don’t leave employees to figure out the benefits on their own. Do learn the details of the company’s coverage for obesity treatment. Do advocate for benefits that support people living with obesity: Anti-obesity medicationsDiet and nutrition programsWeight-loss surgeryPrescription digital therapiesObesity specialistsExercise programs Mental health professionals, nutritionists and dietitians Don’t go it alone. Tap into resources for employers:Healthy People 2030The CDCSTOP Obesity AllianceObesity Care WeekThe Milken InstituteHarvard TH Chan School of Public HealthBusiness Group on HealthThe AllianceHR DiveEmployeesHow to advocate for health benefits not covered by insurance Tell your employer what coverage would help you manage your disease:Anti-obesity medications Surgery Programs or interventions Obesity care specialists Read: Dear Employer: How to Ask for Obesity Care Insurance Coverage Calculate your out-of-pocket costs. Let your employer know where your health insurance benefits fall short and what that costs you.Share healthcare provider recommendations for treatments and programs and ask your employer to add them to the benefits package for everyone. Find more information you can use to advocate for coverage of obesity care:Facts about obesity from the CDCInformation about causes of and treatments for obesity from Mayo ClinicInformation about obesity treatments from the Obesity Action CoalitionTypical costs of weight-loss surgery from Money.comTips for reviewing your health insurance policy for obesity coverage from the Obesity Action CoalitionTalking points and tips from the Obesity Medicine AssociationResources from Obesity Care WeekFast facts about obesity from STOP Obesity AllianceInformation about coverage for weight-loss medications from Becker’s Payer IssuesInformation about participating in clinical trials from the National Institutes of HealthThis educational resource was created with support from Eli Lilly and Company.

La obesidad es tan común en Estados Unidos que casi la mitad (4 de cada 10) adultos estadounidenses viven con la enfermedad, lo que implica riesgos médicos graves y puede causar muertes prematuras. Muchas personas que viven con obesidad enfrentan discriminación o malos tratos en el lugar de trabajo. Los empleadores pueden ayudar a reducir el estigma, a mejorar los entornos laborales para personas con obesidad y a garantizar que los beneficios de los empleados cubran programas y tratamientos necesarios desde el punto de vista médico. Cubrir tratamientos para la obesidad no solo mejora la salud y el bienestar de los empleados, sino que también puede reducir los costos de atención médica de la compañía. Los empleados también pueden jugar un papel importante defendiendo su derecho a satisfacer sus necesidades y a un trabajo que opera en función de justicia, compasión y respeto. Aquí encontrarás cómo abordar la obesidad y su correspondiente cobertura de seguro médico en el lugar de trabajo. Empleadores: Cómo hablar de la obesidad Di: Las personas que viven con obesidad No digas: Personas obesas, gordas o con sobrepeso. Cómo pensar en la obesidad Reconoce que la obesidad es una enfermedad, no una falla personal o un estilo de vida. No asumas que los trabajadores que viven con obesidad no tienen motivación o profesionalismo. Reconoce que, para algunas personas, la dieta y el ejercicio no son suficientes para disminuir de peso. Podrían necesitarse medicamentos o cirugías. Cómo comunicarse con empleados que viven con obesidad Compórtate con respeto, compasión y sinceridad. No ignores las preocupaciones de otras personas. No juzgues ni te burles de la apariencia o experiencias de otras personas. Qué puedes hacer para apoyar a personas que viven con obesidad No dejes que los empleados tengan que determinar los beneficios por su propia cuenta. Aprende la información de la cobertura de la compañía para el tratamiento de la obesidad. Promueve beneficios que proporcionan apoyo a personas que viven con obesidad: Medicamentos contra la obesidad Programas dietéticos y nutricionales Cirugías de disminución de peso Terapias digitales de prescripción Especialistas de la obesidad Programas de ejercicio Profesionales de la salud mental, nutricionistas y dietistas. No lo hagas sola. Aprovecha recursos para empleadores: Healthy People 2030 Los CDC STOP Obesity Alliance Obesity Care Week The Milken Institute Facultad de salud pública TH Chan de Harvard Business Group on Health The Alliance HR Dive Empleados: Cómo promover beneficios médicos no cubiertos por los seguros Di a tu empleador qué cobertura sería útil para que manejes tu enfermedad: Medicamentos contra la obesidadCirugíasProgramas o intervencionesEspecialistas en la atención de la obesidadLee: Estimado empleador: Cómo solicitar cobertura de atención para la obesidad >>Calcula tus costos sin reembolso posterior. Informa a tu empleador cuáles son las deficiencias de los beneficios de seguro médico y lo que te cuestan.Comparte recomendaciones de proveedores de atención médica en lo que se refiere a tratamientos y programas y pide a tu empleador que los agregue al paquete de beneficios de todos. Encuentra más información que puedes usar para promover la cobertura de atención de la obesidad:Información de los CDC relacionada con la obesidadInformación de la Clínica Mayo acerca de las causas y de tratamientos de la obesidadInformación de tratamientos contra la obesidad de Obesity Action CoalitionCostos comunes de cirugías de disminución de peso de Money.comConsejos para revisar la cobertura contra la obesidad de tu póliza de seguro médico de Obesity Action CoalitionConsejos y puntos importantes de Obesity Medicine AssociationRecursos de Obesity Care WeekInformación resumida de la obesidad de STOP Obesity AllianceInformación de la cobertura de medicamentos de disminución de peso de Becker’s Payer IssuesInformación sobre la participación en ensayos clínicos de los National Institutes of Health [Institutos nacionales de la salud]Este recurso educativo se preparó con el apoyo de Eli Lilly and Company.

+ PDF text SLIDE 1 Living with Obesity? Quick tips for how to navigate health insurance coverage for obesity care SLIDE 2 Obesity is a disease that affects 4 out of 10 American adults. Medication, surgery, diet and exercise programs, and working with mental health professionals can help people lose weight but can be expensive. Will insurance cover these costs? Here’s how to find out. SLIDE 3 Health insurance plans don’t cover everything. Some services are specifically not covered. Check for exclusions and inclusions: Does your policy say they will or won’t cover obesity treatments such as medications, surgery, obesity specialists or nutrition and exercise programs? SLIDE 4 Check the drug list (sometimes called “formulary”). Look at the type (e.g., capsule vs. injection), dosing and brand. Some versions may not be covered. The list can change any time. If the plan stops covering your medication, they’ll give you advance notice. You may be able to appeal. SLIDE 5 A tiered formulary divides drugs into groups based on cost. Lower tiers = lower costs Higher tiers = higher costs and may have more restrictions or hurdles to jump through Each plan is different. Be sure to check the policy documents for your plan to make sure your medications are covered. SLIDE 6 Plans may have extra requirements for some medications: Quantity limits: You can only get a certain amount of medicine at a time. Step therapy: You have to try and fail other medicines before they’ll cover your drug. Prior authorization: You have to request and get approval in advance. SLIDE 7 Before weight-loss surgery, you may have to meet requirements. These can include: Medical necessity: Show that weight-loss surgery is key to your health Diet program: Complete a supervised diet Psychological evaluation: Show that you’re emotionally ready for surgery and related changes SLIDE 8 Estimate your costs: Deductible: The amount you pay before insurance starts to pay Copayments: Your fee for a prescription or service Coinsurance: A percentage of costs for medications or services that you pay after meeting your deductible Out-of-pocket maximum: The most you’ll pay for covered services in a plan year SLIDE 9 Is your healthcare provider (HCP) covered? Check the provider directory to see if the plan covers your HCP or facility. Some plans let you go outside the network if you pay more. Some plans (like HMOs) pay nothing unless you see a participating provider. SLIDE 10 Don’t get stuck without coverage for treatment you need. Arm yourself with information. When in doubt, contact the health plan to confirm what’s covered and what it’ll cost you. If you have health insurance through a job, ask HR for help. This educational resource was created with support from Eli Lilly and Company.

Menopause is a near-universal experience for women in midlife. And most women will experience some physical, mental and emotional changes in the years leading up to, and following, the end of their menstrual cycles. While vasomotor symptoms such as night sweats and hot flashes are common for most women, how long they last and how severe they can be vary by race and ethnicity. Cultural norms can have a significant effect on how women experience menopause as well. Read: Menopause Symptoms Are Far from Universal >> “I had a Latina patient struggling to process what was going on physically in terms of her hot flashes and her night sweats, but also feeling there was no one she could reach out to about what she was feeling emotionally,” said Makeba L. Williams, M.D., a professor in the department of obstetrics and gynecology at the Washington University School of Medicine in St. Louis. “She said her village was there for her when she had her babies, but no one talked to her about what to expect during menopause. She was almost afraid to tell her mom she was contemplating hormone therapy because that was countercultural for her.” As with other health conditions, racial, ethnic and cultural disparities can make a difference in menopause care. We spoke with Williams about the connections between racial disparities in menopause and what women can do to make sure they receive care that honors their personal and cultural needs. This interview has been lightly edited for clarity and length. HealthyWomen: What data exists on racial differences in menopausal symptoms?Makeba L. Williams: In the SWAN study of women’s health, we found that African American women report having more hot flashes and night sweats. They get them more frequently and also for a longer duration — on average 10 years. It’s almost 9 years for Hispanic women, 6.5 years for non-Hispanic white women and even fewer years for Asian women.HealthyWomen: Do we know the reasons for these racial differences?Makeba L. Williams: We don’t know what exactly drives them. But if we think about women’s health in the midlife transition in a holistic way, vasomotor symptoms like hot flashes and night sweats can be markers for cardiovascular disease. When we look at who’s impacted the most by cardiovascular disease, we come back to African American women. This connection leads to more overall disparities for African American women’s health. HealthyWomen: Living in neighborhoods with higher concentrations of air pollution and less greenspace may be associated with a younger age at menopause. What might be the correlation between those factors?Makeba L. Williams: We’re still trying to understand how environment impacts the menopausal transition. Is there a direct relationship? Or is it one that’s affected by other factors, where exposure to air pollution and less access to greenspace causes other conditions that lead to a younger age at menopause? It’s an area to be explored, but we know that socioeconomic disadvantages, stress, caregiving responsibilities, and chronic exposure to racism and discrimination are associated with worsening symptoms. We see many of those factors in African Americans who have these disproportionate levels of menopausal symptoms. HealthyWomen: What other connections did the SWAN study uncover?Makeba L. Williams: We saw elevated cigarette and tobacco use among African American women and less physical activity. Longer durations of hot flashes and night sweats were associated with stress, lower educational attainment, anxiety, financial strain, poor social support, obesity, smoking and being unpartnered. There’s still a lot we don’t know, as women of color have been excluded in large numbers from menopause research. We need to be more inclusive in our recruitment of diverse research populations so we have a better understanding of what’s driving these disparities. Watch: HealthyWomen Congressional Briefing: Women in Clinical Trials >> HealthyWomen: Can cultural frameworks of menopause affect women’s physical, mental and emotional symptoms?Makeba L. Williams: Culture can make a difference in what women disclose to others, what they talk about and what’s normative. White women might be more likely to seek treatment, while some women of color might feel they have so many other things they’re worried about and not seek treatment. In the grand scheme of things, the thinking might be, “Do I have time to be worried about a hot flash or a night sweat? Or a little weight gain in my midsection even though I’m working out?” We can also think about differences in body shapes, what bodies are celebrated in different communities and how weight is distributed, which means weight gain might not be seen as problematic in some non-white cultures. While 80% of menopausal women will experience hot flashes and night sweats, the level of bother can be very different, and what those symptoms represent may mean different things across cultures. HealthyWomen: In many western nations, menopause is often depicted as a negative experience. Does that differ outside western contexts?Makeba L. Williams: One common theme in the literature is that many minority women perceive this transition as a positive one. They have a posture of acceptance, and laugh their symptoms off because in the grand scheme of things, they feel they have all these other positive benefits to being in midlife and menopausal. Many will feel liberated for the first time in their life because they don’t have some of the challenges associated with the reproductive period, like pregnancy or bleeding. If you’re African American and disproportionately impacted by fibroids, when your period stops, suddenly you’re not worried about having to remember a second pair of clothes or altering your daily activities because you don’t know when your period might show up. Also, in many cultures, reaching a certain age and point of maturity comes with respect. There’s a feeling you’ve reached this vaunted station in life. HealthyWomen: What is the best way to be prepared going into menopause, regardless of your cultural background?Makeba L. Williams: Every woman deserves to have the best menopausal care. That might look like asking your healthcare provider for guidance about menopause in general. That might look like advocating and saying, “I know there are differences from one person to the next and how they experience menopause. Tell me more.” I hate to see women continuing to suffer in silence because their mothers or their aunties did, and because their own healthcare provider doesn’t bring up the topic. I want patients to have agency in seeking information and then deciding what’s best for them. This resource was created with support from Astellas.

Jodi Miller, 49, was experiencing distressing changes to her skin, weight, moods, sleep schedule and menstrual cycle. But when she talked to her OB-GYN, she didn’t get much help. “I was told that all of what I was experiencing was a part of ‘the change’ and that there was nothing that could be done,” Miller said. She got a similar response from other healthcare providers (HCPs) in her area. So she searched the internet for a specialist in midlife women’s health. She stumbled on an online clinic that focuses on women who are in menopause and perimenopause, the period leading up to menopause. Read: 3 Tips for Finding a Healthcare Provider Who Specializes in Menopause >>This was Miller’s first time using telehealth, so she didn’t know what to expect. But she has been delighted with the care she’s received. Miller said the care she gets virtually is better than the in-person care she had access to. The visits are thorough, personal and informative. The HCP listens and asks good questions. “Our Zoom calls are more connective than any face-to-face I have had,” she said. “My relationship with this telehealth service has changed my life.” Managing menopause with telehealthEvery year, more than 1 million people assigned female at birth go through menopause in the United States. Symptoms of perimenopause and menopause can include: Vasomotor symptoms (hot flashes and night sweats)Genitourinary syndrome of menopause, which includes vaginal dryness, burning and irritation, lack of lubrication, pain during sexual intercourse or penetration, urinary urgency and urinary tract infectionsChanges in weight, sleep and moodThinning hairDry skinTooth decay, dry mouth and receding gums People in menopause can also face serious health risks. These include increased risk of heart disease and stroke, and bone density loss. Some health conditions and symptoms require a physical exam or lab tests, which must be done in person. But more and more, women are turning to their laptops and phones to get menopause care via telehealth. Virtually, HCPs can provide guidance for managing symptoms, prescribe treatments, and identify signs or symptoms that require in-person follow up. Many HCPs now offer remote visits, which can build on existing relationships. Plus, menopause-specific and broader women’s health telehealth services are becoming more popular. These new options can help fill gaps among local HCPs who may not know much about menopause. In a 2017 study, 2 out of 10 medical trainees surveyed said they had zero lectures on menopause during residency. And only 7% said they felt well-enough prepared to manage menopause care. “There aren’t as many healthcare providers who are familiar with treating menopause as you might think,” said Karyn Eilber, M.D., professor of urology and associate professor of obstetrics and gynecology at Cedars-Sinai Medical Center and a co-author of “A Woman’s Guide to Her Pelvic Floor: What the F*@# Is Going On Down There?” Finding an HCP with menopause expertise is especially important because women may not know all the symptoms of menopause, and they might not recognize what is happening. Virtual visits with a specialist can be a way to get accurate information, diagnosis and treatment. “If you don’t have a menopause provider near you, it’s better to have a telehealth consultation than settle for [poor] management of your menopausal symptoms,” Eilber said.Telehealth and accessThe convenience of telehealth may also help more women get care. Perimenopausal and menopausal women are usually in their 40s and 50s. This can be a particularly busy time for people who are juggling family and work responsibilities. Women who might not take the time to see an HCP in a physical office may be more likely to seek care from the comforts of home and on their schedule. Convenience won over Laura Goetz, 56, a social worker based in Wisconsin. “The ease of telehealth around my work schedule was wonderful,” Goetz said. Goetz also said that she had found that many HCPs in her area were lacking knowledge about menopause. So, telehealth allowed her to access care from more qualified specialists than she could find locally. Read: Women Deserve Care from Healthcare Providers Who Understand Menopause >> Although telehealth has worked for Goetz so far, she noted that online health services may not be an option for everyone. Cost, technology and language barriers can keep some people from accessing telehealth. “The biggest drawback I see as a social worker is that many women cannot access telehealth for menopause as many providers do not accept insurance or they do not have access to the technology needed for a virtual visit,” Goetz said. Racial and other disparities in menopause have been well documented over the years. And even women with health insurance may struggle to pay out-of-pocket fees that can come with telehealth visits. “It’s wonderful that menopause awareness is finally getting attention. But many women still do not have access to the quality care they deserve,” Goetz said. “I worry that, for the moment, quality menopause care is only available to women with the financial means to pay privately … it seems we are failing women when they need help the most.”How to choose a telehealth provider for menopause care When choosing a provider, it’s important to do your research first. “I would choose a telehealth service with licensed providers in your state, and one that accepts your insurance if you have coverage,” said Kim Langdon, M.D., an Ohio-based OB-GYN who works with an online HCP and pharmacy. Eilber said that’s a step women should take, whether they’re choosing a telehealth provider for menopause or anything else. “Even though it’s telehealth, the provider still has to be licensed in the state where you legally reside,” Eilber said. “As for a menopause provider, it’s best to seek someone who has experience and/or certification in treating menopause.” Use: The Menopause Society Find a Provider Tool >> Once you’ve chosen a telehealth provider, make sure they take a full medical history. Also make sure that your visit includes a real video visit and not just a questionnaire reviewed by a bot, said Lisa Larkin, M.D., president of The Menopause Society and member of HealthyWomen’s Women’s Health Advisory Council. “Find out if you can access the same provider for follow-up needs,” Larkin said. Larkin also suggested asking these questions when choosing a telehealth provider: Can the provider refer you to an in-person practice if needed? Can you fill prescriptions anywhere or do you have to get them from the telehealth provider?Can you access the notes from your visit to share with other HCPs you may see? How much will visits cost and will your insurance cover the visits?No matter who you see, Eilber said she encourages women to be active participants in their care. “Women should feel comfortable asking as many questions as needed,” she said.ResourcesThe Menopause Society The Menopause Society Find a Provider ToolThis educational resource was created with support from Astellas.