The alarm bells should ring in Congress: a disease that is already one of the leading killers of Americans is now expected to afflict nearly half of all adults over the next eight years.
The disease is obesity. For decades, this was seen as a personal moral failure. Science has proven that to be wrong, just as chemistry has shown drug addiction to be insensitive to “just saying no.” Congress must act because body shaming cannot replace national health care policy.
Today, more than 4 in 10 American adults are obese, up from 3 in 10 in 2000. Those defined as having severe obesity have increased even faster, from about 1 in 20 to 1 in 10.
Obesity kills 300,000 Americans each year, and poor diet is the leading risk factor for death in the United States. Obesity is also an underlying condition in nearly a third of COVID-19-related hospitalizations. It damages nearly every system in the human body, leading to diabetes, heart disease, stroke, several forms of cancer, mental illness, difficulty in physical functioning, and many other illnesses.
Strikingly, the medical establishment spent nearly a quarter of a trillion dollars in 2020 to treat conditions where obesity was a primary cause, but spent alarmingly little to prevent or treat obesity itself. same. Not only does preventing obesity and obesity-related diseases eliminate unnecessary suffering and death, it also makes financial sense. A 2022 Bipartisan Policy Center report, co-authored by one of us, concluded that obesity costs $248 billion (in 2020) in annual medical expenses, or 6.2% of total expenses. A health microsimulation model from the USC Schaeffer Center found that obesity is a bigger risk to public finances than smoking.
Despite this, Medicare and private insurers cover few obesity treatments. Currently, coverage is limited to behavioral counseling in primary care settings and weight loss surgery for people with severe obesity and other related conditions, leaving most obese people with too little health. effective options.
More intensive behavioral counseling could help tackle obesity, but Medicare fails by limiting coverage to primary care providers who are rarely fully trained in weight management and lack the time to perform lengthy procedures. Intensive behavioral counseling could be delivered more effectively — and potentially at lower cost — by specialist providers, including dietitians and psychologists. Medicare coverage for medical nutrition therapy — a type of nutrition counseling provided by a dietitian — is also limited to people with diabetes or kidney disease, leaving out care for people with obesity and many other diet-related illnesses.
When Medicare drug insurance was created nearly 20 years ago, Congress banned coverage for weight loss therapies on the grounds that they were cosmetic rather than health treatments. As they usually do, private insurers have followed suit: less than 10% of people have commercial health insurance that covers weight management drugs.
Despite Medicare’s lack of incentive, five drugs have hit the market that can reduce weight by 6-16% over 52-68 weeks. Reducing just 5% of body weight improves blood sugar, blood pressure, triglycerides, HDL cholesterol, sleep apnea and other chronic diseases. Medications are safe and important tools for the health of Americans, but cannot contribute significantly to the fight against obesity without insurance coverage.
Bipartisan bills in Congress aim to address the problem.
The Treatment and Abatement of Obesity Act (TROA) has been introduced through the senses. Tom Carper (D-Del.) and Bill Cassidy (R-La.), Reps. Ron Kind (D-Wis.), Raul Ruiz (D-Calif.), Brad Wenstrup (R-Ohio), and former Rep. Tom Reed (RN.Y.). This would expand Medicare coverage to include FDA-approved prescription drugs for chronic weight management and intensive behavioral counseling from dietitians and other specialists.
Another bipartisan bill, the Medical Nutrition Therapy Act, was introduced by the senses. Susan Collins (R-Maine) and Gary Peters (D-Mich.) and Reps. Robin Kelly (D-Ill.) and Fred Upton (R-Ill.). This bill would expand Medicare coverage for medical nutrition therapy (MNT) to include obesity and other diet-related illnesses and allow a range of professionals to refer to the service.
Beyond access to medicines and nutritional advice, bipartisan political leadership is needed to advance policies that improve nutrition security for all. In the United States, childhood obesity is more common than childhood hunger, even in low-income households. The reauthorization of child nutrition – which includes the national school meals program and the special supplementary nutrition program for women, infants and children, among other programs – should be adopted in a bid to combat childhood obesity by improving food and nutrition security. In addition, the reauthorization of the Farm Bill by the upcoming 118th Congress will provide an opportunity to elevate the quality of food under the SNAP (Supplemental Nutrition Assistance Program), known as the “food stamp” program.
Medicare and private insurers pay for treatments for diabetes, heart disease and high blood pressure. If the goal is to save lives, then logic, clinical evidence and compassion dictate that they should also be paying to prevent and treat obesity, now.
Anand Parekh is a board-certified internal medicine physician, chief medical adviser at the Bipartisan Policy Center, and former deputy assistant secretary of health at the U.S. Department of Health and Human Services. Dana Goldman is Dean of the Price School of Public Policy and Co-Director of the Schaeffer Center for Health Policy & Economics at the University of Southern California.
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