Recent work demonstrates the benefits of weight loss from intensive lifestyle modification. One barrier to counseling may be lack of reimbursement. We sought to quantify the obesity coverage policies of insurers in Pennsylvania. A three-page questionnaire was sent to eligible Pennsylvania health plans. Respondents included company medical directors and administrators from other departments, including public relations, provider relations, disease management, and utilization review. The questionnaire inquired about major treatment modalities for obesity, including details of coverage. Sixteen of 19 eligible plans (84%) responded. All plans provided some coverage for bariatric surgery. Nine out of 16 companies (56%) stated that they covered individual dietary counseling, but only five paid for intensive counseling. Less than 50% of plans reimbursed other forms of lifestyle modification or weight loss medication. Surgery was covered significantly more often than all other treatment modalities (P<0.02 for all comparisons). No differences in reimbursement were found by plan type or by number of enrollees. Insurance reimbursement for obesity in Pennsylvania does not consistently reflect recent evidence for the benefits of lifestyle modification. Given the increasing evidence for the clinical and cost-effectiveness of nonsurgical weight loss therapy, coverage policies may begin to change.