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Mary Hague, RD, is senior manager of regulatory affairs and Pam Michael,RD, is director of quality, outcomes, and coverage for the American DieteticAssociation.
The American Dietetic Association applauded this summer when the Centersfor Medicare & Medicaid Services (CMS) took a much-needed step towardproviding millions of Americans high-quality treatment for obesity and itsrelated conditions—by simply eliminating the coverage manual statementthat obesity is not an illness.
The American Dietetic Association is the nation's largest food andnutrition association, with 67,000 members who touch the lives of millions ofAmericans every day.
Our members work in schools, hospitals, physician offices, and in a varietyof institutional food service settings. More than 65% of our members areengaged in client or patient counseling, and they see more than 35 millionpeople directly in that setting alone. Their focus is helping people maintaintheir health through nutrition and sound food safety practices and byincorporating daily physical activity in their lives.
We recognize that obesity involves complex interactions between genetic,physiological, psychological, metabolic, and environmental influences. Andlike others, we are concerned over the rapid growth in the number of Americanswith clinically severe obesity. The implications of an obesity epidemic areenormous. The Rand Corporation predicts that if historical obesity trendscontinue, 1 in 5 health dollars will be spent on treating the consequences ofobesity in individuals aged 50–69 in 2020, compared with less than 1 in10 health dollars in1985.1 For thatreason alone, effective strategies to reverse this trend are essential.
However, it is even more compelling to address obesity so that individualsare not cheated from productive, healthy lives and their families are not leftto cope with the often-fatal, serious illnesses that result from excessivebody fat.
This summer, the National Institutes of Health (NIH) outlined healthproblems that develop inobesity.2 It is amajor risk factor for type 2 diabetes, heart disease, high blood pressure,stroke, certain kinds of cancer, sleep apnea, asthma, osteoarthritis, urinaryincontinence, metabolic syndrome, and other conditions and diseases. Type 2diabetes, long considered an adult disease, has dramatically increased inchildren in parallel with obesity—and we can only expect that withoutserious intervention, elevated blood glucose levels will wreak havoc onchildren's health, potentially resulting in blindness, kidney and heartdisease, and other serious medical problems.
Both body weight and blood glucose need to be kept in a healthy range. Formany obese individuals, that means losing weight. The good news is that amodest weight loss of 10% (just 20 pounds for a 200-pound person) can improveglucose metabolism, blood lipid levels, and blood pressure.
The recent decision by CMS to remove the phrase "obesity is not adisease" from its coverage manual opens the doors to conversations aboutwhen and how to treat obesity in Medicare beneficiaries. It doesn'tnecessarily mean that obesity treatments will be covered, but this step beginsthe analysis process of determining the suitability or cost-effectiveness ofvarious treatments. Before this decision, obesity could only be treated if itwere associated with another disease.
Ironically, in this debate, CMS is acting essentially as an insurancecompany, deferring to the NIH and other bodies of medical and scientificresearch expertise, aware that for nearly two decades, NIH has referred toobesity as a disease. As for private insurance companies, each has theprerogative to choose which treatments to cover, whether surgical, drug, ormedical nutrition therapy by a registered dietitian.
The medical model of obesity can be considered largely pragmatic: Callobesity a disease and it is possible that health insurance will cover itstreatment. That matters to individuals' lives and the public's health.
References
2. NIH Obesity Research Task Force: Strategic Plan for NIH ObesityResearch. August 2004.
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