Access to Treatment: Policy Approaches to Curbing the Obesity Epidemic

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Obestiychartsblog

By Christine Petrin

If you haven’t seen this image in one of your classes yet, well just give it time. I can count at least six separate occasions where these maps have made an appearance in Milken 100, and I’m only halfway through the MPH program. While most public health students already have a pretty decent understanding of the toll the current obesity epidemic is having across the country, a lot of the focus in the public health world (and in the policy world) has been prevention. However, my work with the STOP Obesity Alliance over the past year and a half has made me more acutely aware of policy solutions aimed at treating and managing obesity.

Here are a few statistics that you probably already knew…

Obesity affects more than one-third of adults in the United States and is associated with more than 100 chronic health conditions, including heart disease, stroke, diabetes, and cancer. The problem is widespread, with more than two-thirds of states having obesity prevalence above 25%. Unfortunately, rates of obesity have increased dramatically over the past three decades, and it’s not just health care providers who are feeling pressure to address this disease.

Now here are some statistics that might be new…

Obesity is estimated to cost the US healthcare system $190 billion in annual direct medical costs, and some researchers suggest the societal cost could reach $1.1 trillion over a lifetime. Obesity contributes 11.8% of Medicaid costs and 8.5% of Medicare costs, $7 billion of which is obesity-attributable prescription drug spending. Altogether, these programs spend $61.8 billion on obesity annually. Despite numerous public health initiatives addressing diet and physical activity, the obesity epidemic continues to rise. Policymakers are now beginning to realize that patients need access to a wider range of treatment options.

But first, a quick history lesson…

The Centers for Medicare and Medicaid Services (CMS) first addressed the growing burden of this disease in 2006 by including bariatric surgery in Medicare coverage. By 2011, CMS had added coverage of intensive behavioral therapy (IBT) for obesity for individuals under Parts A and B of Medicare. Unfortunately, this coverage only applies to primary care physicians, nurse practitioners, clinical nurse specialists, and physician assistants.

Conspicuously missing from the list are:

    • Clinical psychologists;
    • Registered dietitians;
    • Health/fitness professionals;
    • Trained health educators;
    • Nutrition professionals; and
    • Other providers uniquely situated to address obesity outside of a primary care setting.

In fact, any counseling that occurs outside of a primary care office is not covered, including several community-based lifestyle counseling programs whose efficacy with other chronic diseases has already been demonstrated.

Current regulation also excludes obesity drugs from Medicare Part D Coverage. When Part D was enacted in 2005, there were no FDA-approved obesity medications on the market, and Congress, rightfully so, did not want to cover a non-approved treatment option. A decade later, there are 10 medications approved by the FDA for weight loss. The Part D statute is now pitifully outdated, especially considering many commercial payers and Medicare Advantage plans have begun covering these approved drugs.

So what’s happening now?…

A bill introduced in both the Senate and House this summer seeks to remedy some of these problems. The Treat and Reduce Obesity Act of 2015 expands counseling opportunities for patients with obesity and also allows coverage of new FDA-approved weight management drugs. Additionally, the Act would require the Department of Health and Human Services to report to Congress biannually with recommendations to better coordinate the U.S. government’s response to the obesity epidemic.

Since its introduction, the bill has gained little traction in either chamber. Even if the Treat and Reduce Obesity Act spends the rest of this Congress gathering cobwebs, a policy approach to obesity treatment reform is practically inevitable. Patients with obesity deserve full access to low-cost, quality care, and the rest of the country desperately needs to bend the Medicare cost curve; continuing to ignore insufficient coverage and access to treatment is simply unsustainable.

Christine Petrin is a second year MPH Health Policy student and the President of HPSA. She works as a Research Assistant at the STOP Obesity Alliance. 

Image courtesy of the Centers for Disease Control and Prevention.

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