An Oct. 13 article incorrectly described Blue Cross Blue Shield of North Carolina's estimate of its costs for obesity-related illness in 2003. The correct estimate was $83 million. (Published 10/20/04)

Alarmed by the obesity epidemic, North Carolina's largest health insurance company announced yesterday that it will offer more than 1 million of its members the most comprehensive package of benefits ever provided to prevent and treat weight problems.

Blue Cross and Blue Shield of North Carolina will begin paying for four visits to a doctor every year specifically to assess a patient's weight and provide treatment if necessary, nutritional counseling sessions with dieticians to help people stay thin or shed pounds, and two prescription diet drugs for those already overweight. Contrary to industry trends, the company will also continue to cover stomach surgery for the obese.

"This is the public health crisis of the 21st century," said Robert Greczyn Jr., president and chief executive. "Public health experts believe that, without a dramatic change, the coming generation will die at a younger age than our generation. We are going to do more about obesity. We want to walk the walk."

The decision was hailed by anti-obesity advocates as a groundbreaking step that will enable patients and doctors to take a more active role in preventing people from becoming overweight in the first place and treating them if they do.

"This is very positive," said Morgan Downey, executive director of the American Obesity Association, a Washington advocacy group. "It's very comprehensive and unprecedented in terms of covering people across their weight-spectrum needs."

The move will probably become a model for other insurers and private companies, which are becoming increasingly alarmed by the skyrocketing costs associated with obesity, experts said. More than two-thirds of Americans are overweight, including about a third who are obese.

"Other insurance companies and health plans and employers will be watching this very closely," said Helen Darling, president of the National Business Group on Health, a coalition of many of the country's largest companies. "If it proves to make a difference, then I think more employers will think about doing something like this, at least on a pilot basis and maybe more."

The North Carolina insurer is the first to significantly expand coverage for weight treatment since Medicare announced this summer that it was dropping a long-standing policy that did not recognize obesity as a disease. That decision was hailed as a watershed that would open the door for the federal program to cover obesity treatments, such as surgery, and that could prompt private insurers to follow suit for a variety of weight-loss treatments.

"Medicare opened the door for change last summer when the agency struck language that blocked the treatment of obesity as a stand-alone condition," Greczyn said. "At Blue Cross and Blue Shield of North Carolina, we are proud to step out front. We will treat obesity as a primary condition."

The company decided to launch the new package of benefits, called Health Lifestyle Choices, because half of its members are overweight or obese, triggering medical problems that cost the company more than $83 billion in 2003 alone, he said.

The package includes:

* Paying for four doctor's office visits each year and any related tests to determine whether a patient has a weight problem and to treat that patient if necessary, beginning on April 1, 2005.

* Paying for two prescription weight-loss drugs that have been approved by the Food and Drug Administration -- Meridia and Xenical -- when deemed medically necessary by a doctor, beginning on Oct. 1, 2005.

* Contracting with licensed dieticians to provide counseling to help patients maintain or lose weight, beginning on Oct. 1, 2005.

* Identifying 12 doctors in seven practices across the state who have demonstrated excellence in performing stomach surgery for obese patients, and continuing to pay for the operations. Patients will be encouraged, but not required, to use these doctors.

The new benefits will be available to about 1.1 million of the company's 3 million beneficiaries for whom the company can unilaterally decide to expand coverage, officials said. Other members could get the benefits if their employers opt to offer them.

The company has not calculated how much the program will cost, but officials said they expect that the added expense will be offset by savings associated with weight problems.

Rising costs -- combined with pressure from drug companies and medical-device makers to cover new treatments, and from government officials and public health advocates concerned about health consequences -- are prompting more insurers to pay for more coverage, experts said.

"All these factors are starting to converge," said Diane C. Robertson of ECRI, an independent health technology assessment company. "I think we're going to be seeing a lot more of this."

The move should remove a significant barrier to the treatment of many patients, doctors said.

"There are thousands of people who could benefit from treatment but are not seeking treatment because it's so expensive," said Kishore Gadde, an obesity expert at Duke University in Durham, N.C. "I know patients who have lost significant amounts of weight but couldn't afford to continue the treatment because it was so expensive."

Officials at several large Washington-area insurers said that they already cover many of the same kinds of care, but that they have no immediate plans to match the North Carolina package.

Staff writer Susan Levine contributed to this report.