The Internal Revenue Service allows taxpayers who are forced to spend thousands of dollars because of obesity to deduct expenses for stomach-stapling surgery, approved weight-loss drugs and nutritional counseling.
"At least one arm of the government recognizes the need to reward people for getting in shape," said Linda Webb Carilli, a spokeswoman for Weight Watchers International Inc.
To claim the deduction, a person must itemize. Deductions are allowed for uncompensated expenses for the treatment of an individual, spouse and dependents if the cost is more than 7.5 percent of adjusted gross income, IRS spokeswoman Kris Moore said.
For example, a person with an adjusted gross income of $50,000 would only be able to deduct medical expenses exceeding $3,750.
The average cost of a gastric-bypass operation is about $25,000. Some, but not all, insurance plans cover them.
The IRS designated obesity as a disease in April 2002 and established deduction guidelines in its Publication 502. Previously, taxpayers only were allowed to claim the cost of weight loss programs recommended by a physician to treat a specific disease associated with obesity, such as hypertension.
"The IRS ruling took a lot of people by surprise," said Morgan Downey, executive director of American Obesity Association. "This takes a different approach from the normal kind of urging everyone to diet and exercise as a lifestyle recommendation because it recognizes obesity as a major medical problem."
The IRS ruling does not define obesity - generally described as excess body fat of 30 pounds or more over ideal body weight, or a body mass index of 30 or more. A doctor's diagnosis is required before the surgery or nutrition counseling costs can be deducted.
There is growing evidence that obesity is taking a toll on the nation's health. The number of obese adults has doubled in 20 years, and is now up to nearly 59 million people, or almost a third of all American adults. Childhood obesity has tripled, with one child in six considered obese.
As the pounds mount, so do health care costs. Obesity increases the risk of high blood pressure, diabetes, gallbladder disease and cancer.
The IRS ruling cited the growing body of research for why it believes "obesity is medically accepted to be a disease in its own right."
Joining a weight control program simply to improve appearance, general health and sense of well-being and not under a physician's guidance does not qualify, Moore said.
And while the IRS allows taxpayers to deduct fees associated with programs such as Weight Watchers and Jenny Craig Inc., it does not allow participants to deduct the expense of diet food. There also is no deduction for joining a gym.
"An expense that is merely beneficial to the general health of an individual is not an expense for medical care," Moore said. "If obesity is the disease, the individual must be enrolled in a weight loss program."
The IRS does not break down medical deductions to determine the number of taxpayers using the obesity rule. Experts acknowledge the 7.5 percent threshold may prevent many from benefiting.
"There's no question that's a pretty high threshold and people who would be exercising and trying to preserve their health probably are not going to have enough expenses to reach that level," Downey said.
However, workers who set aside pretax medical dollars in Medical Savings Accounts and Flexible Spending Accounts through their employers may also benefit because both programs use the IRS definition of medical expenses, Moore said. This also would require a doctor's order to lose weight.
The greatest beneficiaries are those who have obesity-related operations, Downey said. The American Society of Bariatric Surgery estimated 103,200 people had operations to lose weight last year.
Joan Gunter, a group leader and ambassador for Weight Watchers in Kansas City, knows firsthand the pain and frustration those on a tight budget face when dealing with weight loss.
"I was working the hot line, and a woman was on the phone crying, saying that she didn't have any extra money but her doctor had told her that she needed to change her lifestyle or she was going to die," Gunter said.
By Connie Farrow