One Step Past Prevention: New Tools to Limit the Incidence of Obesity
Obesity is a rapidly growing concern in the United States—no pun intended. In 2010, about one-third (33.8 percent) of adults in the U.S., and approximately 17 percent of children and adolescents were considered obese. The government estimates that 30 percent of the Medicare population is obese.
Health care professionals are forced to deal with the reality of these numbers, not only through increased incidence of chronic diseases linked to obesity, but also increased health care bills. In fact, the cost of excess medical care caused by overweight and obesity in 2009 was $127 billion in the U.S. and Canada. After the signing of the Patient Protection and Affordable Care Act, Medicare beneficiaries are now eligible to receive coverage for obesity counseling as an extension of the Act’s preventive services. However, many question whether this is enough to reverse the obesity epidemic.
To qualify for Medicare coverage of obesity screenings and intensive behavioral counseling, patients must have a BMI of at least 30, which is considered obese. According to the conditions set by Medicare, obesity counseling must take place in a primary care setting, defined as “one in which there is provision of integrated, accessible, health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients and practicing in the context of family and community” such as a physician’s office. Medicare coverage of obesity counseling is not covered when provided in skilled nursing facilities, hospitals, outpatient surgery centers, or dietitian’s offices, though.
Although reimbursement for obesity counseling is a great step forward in treatment of the disease and obesity counseling in primary care settings is the most general way to treat patients under Medicare, one may question if it is the best and most efficient way. Seventy-two percent of physicians surveyed by the STOP Obesity Alliance, a broad-based collaboration to which the American Society for Nutrition belongs, said that no one in their practice has been trained to deal with obesity and weight-related issues.
Of all health care professionals, those with an education and training in nutrition such as nutritionists, dietitians and physician nutrition specialists are the most capable of providing obesity counseling. In order to increase the success rate of obesity counseling, coverage should be extended to include not only treatment by a clinician—preferably a physician nutrition specialist—but also by a nutritionist or dietitian. Extending reimbursement of obesity counseling to nutrition experts would allow individuals undergoing treatment to be exposed to deeper knowledge and specific techniques to conquer obesity that primary care doctors may not be aware of or understand to the fullest extent.
In addition, obesity treatment services should be considered as an essential health benefit in qualified health plans to further aid in the treatment of this epidemic. Obesity should not be treated differently from other health conditions, and no evidence-based treatments for obesity should be excluded from insurance coverage. Specifically, preventive services including obesity screening and weight management counseling must be covered so that we move from a reactive society treating disease to a proactive society preventing diseases such as obesity in the first place.
The same idea was brought up in a sign-on letter authored by U.S. Representative Ed Towns (D-NY) and colleagues in the House of Representatives and sent to the U.S. Department of Health and Human Services as President Barack Obama’s administration investigated which services are essential and which ones are not. The letter urges HHS to “better standardize access to obesity treatment services through HHS establishing a comprehensive definition of preventive and wellness services and chronic disease management services within the essential health benefits package under the new health care reform law to include the full continuum of medically necessary interventions, including behavioral, nutritional, pharmaceutical, psychosocial and surgical, to treat those affected by obesity.”
ASN has a strong research focus among its membership, and with that comes immediate access to internationally known experts in the field of nutrition, including specialties such as obesity. The dramatic increase in obesity incidence over recent decades reflects an environment characterized by increased access to abundant and inexpensive food, as well as family and work environments that do not promote physical activity. ASN’s member scientists carry out nutrition research to determine the etiology of obesity, along with the most effective preventive measures and treatment. Nutrition research consistently shows cutting-edge evidence-based treatments for obesity, which go beyond nutritional interventions to also address behavioral, pharmaceutical, psychosocial and surgical interventions.
Through translational research, ASN members are working to understand how obesity negatively impacts the health of individuals. With this knowledge, we are also developing and evaluating strategies to prevent obesity in individuals, aid and maintain weight loss and identify and advocate for environmental and policy changes that best support a healthy weight in the U.S. population. ASN and its members, alongside health care professionals, politicians and other stakeholders, are taking strides to conquer the obesity epidemic one day at a time.
The American Society for Nutrition (ASN) is a professional scientific society dedicated to bringing together the world's top researchers, clinical nutritionists and industry to advance the knowledge and application of nutrition to promote health. ASN’s over 4,400 members are helping Americans to live longer, healthier and more productive lives.
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