Frank Diamond
Managing Editor
MANAGED CARE March 2011. ©MediMedia USA

Blue Cross & Blue Shield of Minnesota hopes that adding weight maintenance to its tobacco program will bolster results

Managing Editor

Mark Twain wrote, “Giving up smoking is the easiest thing in the world. I know because I’ve done it thousands of times.” Was Twain worried about weight gain? Because medical managers at Blue Cross & Blue Shield of Minnesota have decided that that’s one of the main reasons people often can’t quit.

Marc Manley, MD, the plan’s chief prevention officer, says that the insurer has offered its stop-smoking support program since 2000 and that he and his team are continually evaluating the service. In January, it launched a smoking cessation/weight loss program. “We try to remove whatever barriers people are facing,” he says.

The health plan uses trained “quit coaches” who develop tactics geared to the individual, says Manley. Members who enroll in the program also receive access to around-the-clock online support by way of a tool the plan calls “Web coach.” The critical time appears to be the first six months. “The hardest time is right after they quit. That’s really when they need the most support.”

“Members who enroll can call back for more support between 7 a.m. and 11 p.m. seven days a week,” says Manley. “The whole impetus for this is just to help people get through that time of quitting successfully and make it so that they have every resource — so that their concerns about gaining weight are addressed.”

Mary Kate Salley is the senior vice president for client services at Free & Clear, the vendor running Blue Cross & Blue Shield of Minnesota’s smoking cessation/weight loss program.

“Historically, programs focus on quitting smoking and imply that the patients shouldn’t worry all that much about weight gain,” says Salley. The medical literature reports that smokers do indeed gain weight — from 8 to 20 pounds. “So, particularly for women, that could be an issue,” says Salley. “But the added support that we have means that they are able to quit and either maintain their weight or gain less weight than those who received only the initial smoking-cessation support.”

While Free & Clear contracts with employers to provide its service, Blue Cross & Blue Shield of Minnesota is the only health plan it contracts with so far.

According to surveys, Minnesota’s smoking rate has declined from 22 percent in 1999 to 16.1 in 2011. (The newest survey was just released in mid-February. See it at Don’t celebrate just yet, because statistics show that 625,000 Minnesota adults still smoke, as do 56,000 Minnesota high school students. (The information on youth smoking is from a study conducted by the state Department of Health.)


Part of the research done by Blue Cross & Blue Shield of Minnesota involved investigating the long-pondered question of why people tend to gain weight when they quit smoking. “Not everybody gains weight. For most people who do gain weight, it’s only a few pounds,” says Manley. “It’s much healthier to gain a few pounds than to keep smoking.”

That said, people who stop smoking gain weight for different reasons, Manley continues. “Nicotine actually does have some impact on the body’s rate of metabolism. So when people don’t have as much nicotine in their system, their metabolism slows down a little.

“Some people may eat more. If they’re feeling uncomfortable because they’re used to having a cigarette in their mouth, some people substitute eating.”

“Here in Minnesota smoking is costing about $2.87 billion a year just in health care costs,” says Marc Manley, MD, the chief prevention officer for Blue Cross & Blue Shield of Minnesota.

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