Speaking during a recent CQ Roll Call forum, Scott Kahan, M.D., M.P.H., (center) director of the National Center for Weight and Wellness, says physicians and policymakers should not treat patients who are overweight as if they have a weakness. Alex Brill (left), CEO of Matrix Global Advisors, and Don Bradley, M.D., M.H.S.-C.L., of the Duke University Department of Community and Family Medicine, also participated in the discussion.
Obesity is recognized as a health problem that contributes to rising medical costs, yet public policy and medical treatment have not caught up with patients' needs, according to physicians and elected officials who spoke during a recent forum.
As major insurers struggle to address the problem directly, CQ Roll Call recently held a forum that focused on changing both the narrative and national policy on obesity. The Gerontological Society of America sponsored the forum at the Newseum.
The problem of obesity is multifactorial, said speakers at the forum, involving demographic and lifestyle changes that have occurred over many decades. During the 1980s, for example, obesity rates were half of what they are today, according to panelist Alex Brill, CEO of Matrix Global Advisors, a consulting firm that specializes in health care, economic and tax policy issues.
Today, annual health costs associated with obesity are an estimated $150 to $200 billion, including $50 billion among Medicare beneficiaries. In fact, one in four seniors is considered obese, said panelist James Appleby, R.Ph., M.P.H., executive director and CEO of the society.
- Annual health costs associated with obesity are an estimated $150 to $200 billion, including $50 billion among Medicare beneficiaries, according to panelists at a recent forum.
- Resolving the obesity problem means more than providing simple counseling about maintaining a balanced diet and exercise, one panelist observed.
- Stigmatizing obesity influences how patients are treated and how policy decisions regarding insurance coverage are made, said another.
According to former HHS Secretary Tommy Thompson, who also participated in the forum, individuals affected by obesity can help themselves by taking greater responsibility for the problem and eating less while exercising more. "There is no law in the U.S. that says you will get arrested if you don't eat everything on your plate," Thompson said. "Eat and drink in moderation."
But resolving the obesity issue means more than providing simple counseling about maintaining a balanced diet and exercise. Scott Kahan, M.D., M.P.H., director of the National Center for Weight and Wellness, said many physicians are not specifically trained in using obesity medications and are unable to counsel patients about the topic or are uncomfortable doing so.
As a start, Kahan said physicians and others should change the language they use when they are discussing obesity. Physicians can fall into the trap of blaming patients who have the condition.
"We don't do it with other conditions," Kahan said. "We don't call people with cancer 'cancerous' or call people with depression 'depressives.' We should refer to 'a patient with obesity' rather than saying 'he is obese.'"
Patients who struggle with their weight should be treated as someone in need of medical attention, not someone who made bad choices, observed another panelist.
"Obesity is not a sign of weakness or a lack of willpower," said Don Bradley, M.D., M.H.S.-C.L., from the Duke University Department of Community and Family Medicine. "It is a condition."
Moreover, attaching a stigma to obesity influences how patients are treated and how policy decisions regarding insurance coverage are made. Although many commercial insurers now cover prescription medications for obesity, Medicare Part D does not. All the panelists at the forum agreed that policy should change to allow such coverage, and they struggled to explain why CMS has lagged behind private insurers in this regard.
"I haven't met anyone who thinks the policy is a logical one today," said Brill.
When the panelists discussed why Congress excluded coverage of obesity medication in Medicare, Thompson, who was HHS secretary at the time, explained that neither party wanted to provide taxpayer funding for medication for people with this condition.
"I tried to argue against it, but I failed," Thompson said.
Legislators who attended the event said they would soon reintroduce the Treat and Reduce Obesity Act, an earlier version of which was introduced in 2013. The bill would allow Medicare to cover prescription obesity medications.
The Congressional Budget Office continues to calculate that coverage of these medications would be a costly addition to the national budget, but Bradley countered that savings would be realized later. When a patient's weight is reduced, it may lessen the severity of other chronic conditions such as diabetes or congestive heart failure.
Fortunately, one panelist noted, some progress has been made in the policy arena to encourage better dietary habits.
Sen. Thomas Carper, D-Del., mentioned that he sponsored provisions in the Patient Protection and Affordable Care Act that require chain restaurants to post how many calories are in a particular entrée or dessert.
"The government is not telling people what to eat or what to order, it's just making them more informed," he said.
Another provision in the law allows employers to offer reduced insurance premiums to employees who lose weight and quit smoking.
But even with new incentives in place, it remains difficult to continue encouraging healthy behavior. Bradley, a former executive with BlueCross and Blue Shield in North Carolina, noted that even when insurers cover six visits per year with a nutritionist, on average, a patient will only make 1.4 visits annually.
In a medical home setting that includes a behavioral health specialist and a nutritionist, he added, a primary care physician can rely on the nutritionist to counsel patients about dietary issues rather than needing to handle it directly.
One physician asked the panelists about the advisability of giving older patients with obesity medication for the condition when those patients likely already have several prescriptions they may have trouble managing or are unfamiliar with.
Kahan, who consults with such patients daily in his clinic, dismissed the notion that patients with a weight problem are simply seeking another prescription.
"Very few patients come in and say, 'Give me a medication.' That's a myth," he said.
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