Medicare, which covers some 42 million American seniors, will pay for obesity screening and behavioral therapy as part of its portfolio of preventive services.
About 72 million American adults, including about a third of Medicare recipients, are obese, and the related health-care costs total some $325 billion a year. The federal decision will now allow Medicare beneficiaries to see their doctors for regular weight-loss counseling — a low-cost, low-tech solution — and may spur private insurers to do the same.
According to the Centers for Medicare and Medicaid Services’ decision summary, obese Medicare beneficiaries — with a body mass index of 30 or higher — seeking weight-loss counseling may see their primary care physician for one face-to-face visit every week for the first month. Then, Medicare will pay for one face-to-face visit every other week for the next five months. If the patient loses at least 3 kg (6.6 lbs.) over the first six months, Medicare will pay for an additional six months of once-a-month face-to-face visits with the doctor.
Despite the overwhelming rates of obesity in this country, few people have been diagnosed with a weight problem by their primary care physicians. In a 2007 Mayo Clinic study of nearly 10,000 primary care patients, about one quarter were obese; of those, only about 1 in 5 had a diagnosis or treatment plan for obesity. For older patients, the rate was even lower.
As the Los Angeles Times reported:
While research finds that physician counseling can be a powerful prod to weight loss for those who need it, many physicians have been reluctant to offer it. While some of that reluctance has stemmed from an absence of insurance reimbursement for such services, many also cite patient pushback and a lack of effective tools as reasons for shrinking from the task of identifying obesity, counseling patients about its health hazards and getting them started on a weight-loss program.
Medicare coverage isn’t going to change the fact that we still don’t have foolproof tools to help people lose weight, or that patients will push back — no one likes to hear that they’re obese, after all — but if the federal decision helps lead to more obese people losing even small or moderate amounts of weight, it could be life-changing.
“As small of a weight loss as 5% to 7% can lead to a huge health improvement,” Christy Ferguson, director of the STOP Obesity Alliance, told USA Today, noting also that obesity programs should emphasize an overall healthy lifestyle as well as weight loss. “It’s not necessarily weight loss so much as it is increased fitness level and increased health.”
The coverage is effective immediately, so Medicare recipients may be screened as soon as their next appointment.