Breaking Down Barriers: How Insurance Mandates Hurt Access to Obesity Care

November 17, 2025

How Insurance Mandates Hurt Access to Obesity Care: Obesity is one of the most pressing public health issues in America, yet it remains one of the most misunderstood and stigmatized. Despite overwhelming evidence that obesity is a chronic, progressive disease — not a simple “lifestyle choice” — millions of people who need treatment face unnecessary roadblocks to care.

Nowhere is this more apparent than in the world of bariatric surgery.

Insurance Mandates: The Numbers Tell the Story

Research shows that approximately 40% of U.S. adults are obese and 20% of U.S. adults are eligible for weight loss surgery based on current medical guidelines — that’s tens of millions of people.

Yet, each year, only about 1% of those who qualify actually receive surgery. That means millions of people who could benefit never get the care they need. Insurance mandates, limitations and restrictions are one of the biggest reasons why.

Hurdles to Bariatric Care:

Many states, such as Texas, do not mandate coverage for bariatric surgery; therefore, many insurance providers have their own specific and often rigorous criteria for approval.

Insurance approval for weight loss surgery typically requires:

• BMI Criteria: BMI ≥ 40, or ≥ 35 with an obesity-related condition (e.g., diabetes, sleep apnea, heart disease).
• Documented Weight Loss Attempts: Many insurers require 3–6 months (sometimes up to 1 year) of medically supervised diet history. Others may require documentation of a several-year history of obesity.
• Evaluations: Psychological and dietary assessments are required to ensure readiness and address potential risks.
• Lifestyle Commitment: Patients must demonstrate dedication to long-term diet, exercise, and behavioral changes.

While these are all important criteria, they can lead to a delay in treatment, even when a patient’s health is at serious risk. During those delays, obesity-related conditions like diabetes, high blood pressure, and sleep apnea can worsen, reducing quality of life and increasing long-term health risks.

The traditional insurance approval criteria listed above were created based on data that is over 30 years old and existed prior to the modern advances of minimally invasive laparoscopic surgery.

Recently, in response to the growing obesity epidemic and pressing need for treatment, the remarkable advances in surgical technique, and the accumulation and analysis of extensive data and studies demonstrating improved outcomes, many professional medical societies have urged reconsidering the approval criteria for bariatric surgery.

The two largest metabolic and bariatric surgery organizations in the world, the American Society for Metabolic and Bariatric Surgery (ASMBS) and the International Federation for the Surgery of Obesity (IFSO), have recommended updates to the current and outdated criteria:

• Bariatric surgery is recommended for individuals with a BMI ≥35 regardless of other medical problems.
• Bariatric surgery should be considered for individuals with weight-related medical problems and a BMI of 30-34.9.
• BMI thresholds should be adjusted in the Asian population such that a BMI ≥25 suggests clinical obesity, and individuals with a BMI ≥27.5 should be offered bariatric surgery.
• Appropriately selected children and adolescents should be considered for surgery.

Additionally, the ASMBS and the American Association of Clinical Endocrinology (AACE) recommend that individuals with a BMI of 30–34.9 and diabetes or metabolic syndrome may be offered bariatric procedures, though long-term data is limited. They emphasize that surgery should be strongly considered in this group, especially if nonsurgical treatments have failed.

Beyond that, effective August 15, 2025, Cigna expanded bariatric surgery coverage to include patients with a BMI of 30–34.9 plus a qualifying comorbidity such as diabetes. The update also extends coverage to Asian patients with a BMI of 25–27.4 when at least one significant obesity-related condition is present—a progressive move we hope other insurers will emulate.

Getting more insurance companies to lower the threshold could be life-changing for millions of people.

Bariatric surgery isn’t just about the procedure — it should be a holistic and comprehensive process that often includes:

• Pre- and post-op nutrition counseling
• Psychological support
• Exercise programs
• Ongoing follow-up care
• Support groups
• Wellness coaching

While some insurance coverage and clinics do as much as they can to ensure comprehensive support is included, others do not and may only cover the surgery itself, ignoring the comprehensive approach needed for long-term success. Without these supports, patients are left to navigate their health journey alone.

A major reason these mandates exist is bias. For decades, obesity has been viewed as a willpower problem instead of what it truly is: a chronic, complex disease influenced by genetics, biology, and environment.

This stigma shapes policies, leading to limited coverage, unnecessary delays, and higher out-of-pocket costs — all of which discourage people from seeking help.

Until we address this systemic bias, millions will continue to be denied access to life-changing treatment.

While we advocate for better insurance coverage, patients shouldn’t have to wait for policy reform to reclaim their health. Choosing to self-pay can often be:

• Faster — surgery can happen in 30 days or less
• Predictable — no surprise denials or drawn-out approval processes
• Affordable — cost-effective care and financing is available
• Cost-saving — bariatric surgery has been shown to be cost-saving within 1-2 years

At the Nicholson Clinic we offer some of the lowest self-pay pricing in the country to make surgery more accessible to all. Our competitive pricing is one of the reasons we’ve welcomed patients from all 50 states and 11 countries. With financing options, payments can be as low as $122/month for a combo procedure (using insurance for a needed abdominal procedure such as gallbladder removal or abdominal hernia repair and paying out of pocket to add-on a gastric sleeve at the same time) or as low as $284/month for gastric sleeve only.

All self-pay patients receive lifetime follow-up care and support from the team at the Nicholson Clinic. For many, self-pay is a practical way to take control when insurance mandates stand in the way.

It’s Time to Change the System

With nearly 2 in 5 adults currently suffering from obesity but only 1% receiving the life-saving treatment, it’s clear the current system is failing patients. Insurance mandates and coverage gaps are denying millions the chance to improve their health, longevity, and quality of life.

Until change happens, patients deserve providers who will advocate for them every step of the way.

At Nicholson Clinic, we fight alongside our patients — verifying coverage, guiding them through approvals, and offering affordable self-pay options when insurance roadblocks become too great. We believe everyone deserves access to care, without stigma or unnecessary delays.

Don’t let barriers stand in your way to a healthier life. Take the first step today.

Dr. Brian Long specializes in laparoscopic bariatric surgery, performing sleeve gastrectomy, gastric bypass, duodenal switch and revisional procedures with the Nicholson Clinic for Weight Loss Surgery.

ABOUT THE AUTHOR Dr. Brian Long specializes in laparoscopic bariatric surgery, performing Sleeve Gastrectomy, Gastric Bypass, SADI-S, Duodenal Switch, Gastric Balloon and revisional surgery. He also performs minimally invasive gallbladder removal, abdominal wall hernia repair, and hiatal hernia repair to treat acid reflux. With credentials from prestigious hospitals in Washington, DC, and helping troops in the Persian Gulf, Dr. Long has now been with the Nicholson Clinic for Weight Loss Surgery, one of the country’s premier destinations for weight loss, since 2015.

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