Stifling the Enlarging Problem of Obesity

This week at its annual conference, the American Medical Association (AMA) took a giant step forward and adopted a policy recognizing obesity as a disease, and one requiring a range of medical interventions to advance obesity treatment and prevention. The following day, legislation was introduced in the House and Senate with bipartisan support under which Medicare coverage of obesity would be expanded. Certainly, steps are being taken to limit this growing problem. But at the rate it is growing, are we acting fast enough to stop it?

Over the past 30 years, obesity rates in the U.S. have increased dramatically, according to the Centers for Disease Control and Prevention, and obesity is now an epidemic in the United States. Within the Medicare population, over 30 percent of men and women are obese. It is directly or indirectly associated with many chronic diseases, including cardiovascular disease, musculoskeletal conditions, and diabetes.

“Recognizing obesity as a disease will help change the way the medical community tackles this complex issue that affects approximately one in three Americans,” said AMA board member Patrice Harris, M.D. “The AMA is committed to improving health outcomes and is working to reduce the incidence of cardiovascular disease and type 2 diabetes, which are often linked to obesity.”

Although CNN reports that “Some experts worry suddenly declaring one-third of Americans “ill” or “sick” will increase the desire for quick interventions or medications and discourage people from making the lifestyle changes known to combat obesity,” the Medicare program, at least, is already working to counteract that issue.  Since 2011, Medicare has covered intensive behavioral therapy as well as some surgical and non-surgical procedures.

The U.S. Preventive Services Task Force (USPSTF) found that interventions to fight obesity just might work.  The USPSTF found that there was fair to good evidence that high-intensity counseling about diet and exercise, with behavioral interventions aimed at skill development, motivation, and support strategies, produces modest, sustained weight loss (typically 3-5 kg for 1 year or more) in adults who are obese. There was no direct evidence, however, that behavioral interventions lowered mortality or morbidity from obesity. The USPSTF did find that changes in intermediate outcomes, such as improved glucose metabolism, lipid levels, and blood pressure, from modest weight loss provide evidence of health benefits.

Newly legislation introduced would allow Medicare to provide coverage for even more obesity related items, such as prescription drugs for chronic weight management (which is already covered by Medicaid in 20 states).  Titled “The Treat and Reduce Obesity Act” and sponsored by Sens. Tom Carper (D-Del.) and Lisa Murkowski (R-Alaska) and Reps. Bill Cassidy (R-La.) and Ron Kind (D-Wis.), the legislation would require CMS to highlight Medicare coverage on intensive behavioral counseling for obesity for seniors and their doctors. The legislation would also expand the types of providers who could be reimbursed by Medicare for providing counseling relating to obesity.

This is the second time such legislation has been introduced. The first bill met with little support and stalled in committee just last year. Now, the same issue, with bipartisan support, as well as that of the AMA, and various other associations and corporations like Johnson and Johnson, may just make it.