Obesity and weight-loss surgery are serious and growing problems for underwriting insurances, as Nicky Bray explains
The benefits of surgery, other than the obvious reduction in weight, include reduced blood pressure, resolution of conditions such as diabetes, and a general improvement in quality of life.
The risks of surgery vary depending on the type of surgery chosen. They can include post-operative complications such as thrombosis, bowel obstruction and problems with the site of the surgery, such as leaking of the joins between the parts of the intestine or slipping of a band.
Longer-term complications include nutritional deficiency resulting in osteoporosis and anaemia, the need for additional surgery such as abdominoplasty to remove the excess tissue and skin, kidney stones, gall bladder and intestinal problems.
The interest for the underwriters is clearly in the longer-term outcomes of bariatric surgery.
Although there are not many long-term follow-up studies, there are now indications that many patients put back on some of the weight, with an average regain of 20-30% of weight lost. This is most prevalent with gastric banding in comparison with those customers who have a gastric bypass.
Similarly, many patients will find that although their diabetes had appeared cured in the first couple of years after the surgery, 50% will go on to develop diabetes again in later years with a very similar pattern for any history of high blood pressure.
Longer term, there also appears to be a higher incidence of suicide, accidents and accidental overdose or poisoning – maybe due to the psychological impact of adjusting to a new body shape and unpredictable reactions from spouses, friends and family to the ‘new person’.
Overall, while mortality is improved compared with prior to surgery and the short-term life expectancy appears good, relative life expectancy over the longer term is still less than that for the general population. So how do we assess applicants and what sorts of terms may be available for overweight or obese customers, including those who have had gastric surgery?
Obesity loadings
For those customers who have not undergone surgery, then a loading to the premium is applied for life cover, critical illness cover or income protection, depending on the level of overweight and loadings would normally start once a customer has a BMI of 30 or more.
Non-disclosure of weight is very common, from underreporting of only a few pounds to underestimating their weight by more than five stone. Hence, underwriters will often request that the customer attends for a nurse screening or medical exam for higher levels of cover.
Equally, if the customer is significantly overweight, a screening or exam will check for the actual weight and also to find out if there are any complications, such as high blood pressure or sugar in the urine.
For customers who have undergone surgery, a report will be requested from the customer’s GP. Applications would normally be postponed within the first 6-24 months after surgery, depending on the type of surgery which has been performed.
After this time, terms may be available for life, critical illness and income protection. The premium will be based on the customer’s current weight and there may be an additional increase depending on any complications and to reflect the reduction in longer-term life expectancy and increased long term disability risks.
With the debate set to continue on how we try to curb the growing obesity crisis, particularly among the younger generation, obesity and related health implications will remain a key consideration for underwriters when assessing risk.
Nicky Bray is senior underwriting developer at Zurich UK Life
