Taking Aim at America's Waistline
By: Source: AARP Bulletin Today Date Posted: 2004-11-12 15:13:00-05:00
This summer, in jettisoning just six words from its regulations ("Obesity is not considered an illness"), Medicare took a step toward covering treatments for one of the nation’s most intractable health problems.
But while the change marks a new front in the government’s assault on obesity, Medicare beneficiaries should not expect coverage for weight-loss programs anytime soon. Before they can give the thumbs-up to any obesity treatment, Medicare officials first need to see solid evidence that it makes people healthier in the long run.
"What we’d like to see is something more than just weight loss," says Steve Phurrough, M.D., the director of the Coverage and Analysis Group of the Centers for Medicare & Medicaid Services. He says studies will be examined for evidence of improvement in conditions like diabetes and hypertension, but also to see whether patients who lose weight using a treatment live longer as a result.
Medicare’s Coverage Advisory Committee meets this month to review evidence on surgeries that shrink the stomach’s capacity and can lead to dramatic weight loss. Medicare already covers the procedure for people with concomitant illnesses such as diabetes. "We are asking the question, ‘Should we broaden that coverage?’ " Phurrough says.
The government has invited groups to petition Medicare to review other obesity treatments. (The program can’t cover obesity drugs because Congress excluded them from the drug benefit that begins in 2006.) Morgan Downey, the executive director of the American Obesity Association, says his organization may ask Medicare to look at behavioral therapy and dietary counseling provided under a doctor’s supervision.
Obesity experts generally praise Medicare’s new policy as an important shift that could stimulate research and influence private insurers to offer more services.
Blue Cross and Blue Shield of North Carolina recently announced that it would begin covering doctor visits, nutritional counseling and medicines to help obese members manage their weight. Moves like this begin to reverse "a paradox" in the way insurance generally works, says Gary Foster, M.D., clinical director of the Weight and Eating Disorders Program of the University of Pennsylvania School of Medicine. A doctor’s visit to talk about weight management isn’t covered, typically, until the patient’s obesity causes a disease like diabetes. "That’s like saying we’ll pay for lung cancer treatment but we won’t pay to help you stop smoking," he says.
Obesity has become central to the government’s public health agenda because of its alarming—and increasing—prevalence among Americans. Fifty-five percent of the Medicare population is overweight or obese—and, Downey says, the problem is growing even faster in this age group than in the general population.
But obesity is notoriously difficult to treat: Most people who lose weight eventually regain it. It’s now up to researchers to show Medicare that specific obesity treatments can deliver meaningful long-term results. "It’s a wake-up call to the field to say, ‘Look, get some data,’ " Foster says.
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