K. Laus
2012-06-29 05:01:54 UTC
By Melissa Healy, Los Angeles Times
June 25, 2012, 8:23 p.m.
In a move that could significantly expand insurance coverage of weight-
loss treatments, a federal health advisory panel on Monday recommended
that all obese adults receive intensive counseling in an effort to rein in
a growing health crisis in America.
The U.S. Preventive Services Task Force urged doctors to identify patients
with a body mass index of 30 or more currently 1 in 3 Americans and
either provide counseling themselves or refer the patient to a program
designed to promote weight loss and improve health prospects.
Under the current healthcare law, Medicare and most private insurers would
be required to cover the entire cost of weight-loss services that meet or
exceed the task force's standards.
That could all change Thursday, when the U.S. Supreme Courtis expected to
rule on the constitutionality of President Obama's healthcare law, which
requires adoption of certain recommendations from the task force, such as
this one on obesity.
Few private health insurers now reimburse physicians for weight-loss
counseling or pay for programs that patients seek out on their own. A
growing number, in fact, charge obese patients more for coverage a
policy that some public health officials have denounced as punitive and
ineffective.
The task force concluded after a review of the medical literature that the
most successful programs in improving patients' health were "intensive,
multicomponent behavioral interventions." They involve 12 to 26 counseling
sessions a year with a physician or community-based program, the panel
said.
Successful programs set weight-loss goals, improve knowledge about
nutrition, teach patients how to track their eating and set limits,
identify barriers to change (such as a scarcity of healthful food choices
near home) and strategize on ways to maintain lifestyle changes, the panel
found.
In some cases, programs include exercise sessions as well.
The recommendation, published online in the Annals of Internal Medicine,
does not apply to the roughly one-third of Americans who are considered
overweight, those with a BMI from 25 to 29.9.
It follows a November decision by Medicare to reimburse physicians for
providing "intensive weight counseling" to the roughly 14 million obese
Americans insured by the government program.
The new guidelines were met with cautious support by many physicians on
the front lines of the nation's struggle against excess fat.
Dr. Jack Der-Sarkissian, a family medicine specialist at Kaiser
Permanente's Los Angeles Medical Center, called the guidelines a "long-
overdue" prod to physicians to help their patients control weight gain,
which raises the risk for diabetes, heart disease and other health
threats.
He cited a recent study that found that more than half of all obese
patients had never been told by their physician that they needed to lose
weight. "That's just not fair to the patient," said Der-Sarkissian, who
leads Kaiser's adult weight management efforts in Southern California.
"You have to diagnose the patient and have the discussion, even if the
patient doesn't really want to hear it," he said.
But Jeffrey Levi, executive director of the nonpartisan think tank Trust
for America's Health, said the recommendations would put physicians in a
difficult position: Few have the time or resources to provide obese
patients with intensive counseling, he said.
And since programs meeting the standards set by the task force remain
scarce, most doctors won't know where to send their obese patients.
"The question is whether the services will develop fast enough to meet the
potential demand," Levi said.
Susan Pisano, a spokeswoman for the trade group America's Health Insurance
Plans, said it was unclear how the report would affect the industry and
patients. But, she said, "there's a lot being done" already by health
insurers to help their enrollees lose weight.
Obesity and obesity-related diseases are already responsible for an
estimated $147 billion in annual healthcare spending. Widespread adoption
of the panel's recommendation would increase that spending, at least
initially.
The panel acknowledged that one problem with its recommendation was that
no studies have shown such intensive programs provide long-term health
benefits.
There appear to be short-term ones. Two studies cited by the panel found
that patients who received intensive counseling were 30% to 50% less
likely to have Type 2 diabetes two to three years later than those who
received lighter counseling, drug therapy or both.
But the counseling subjects' cholesterol numbers barely budged, and
changes in blood pressure and waist circumference were, on average, small.
A pilot program considered a model by the task force is now being launched
in 21 cities by the federal Centers for Disease Control and Prevention.
It is based on a clinical trial, the Diabetes Prevention Program, that
encouraged modest improvements in food choices and at least 150 minutes of
weekly exercise for participants, who were at high risk for developing
diabetes.
The subjects, who typically met weekly for six months and monthly for the
second half of the year, lost between 5% and 7% of their body weight and
reduced their diabetes risk by 58%.
***@latimes.com
http://www.latimes.com/news/nationworld/nation/la-sci-obesity-screening-
20120622,0,2815818.story
June 25, 2012, 8:23 p.m.
In a move that could significantly expand insurance coverage of weight-
loss treatments, a federal health advisory panel on Monday recommended
that all obese adults receive intensive counseling in an effort to rein in
a growing health crisis in America.
The U.S. Preventive Services Task Force urged doctors to identify patients
with a body mass index of 30 or more currently 1 in 3 Americans and
either provide counseling themselves or refer the patient to a program
designed to promote weight loss and improve health prospects.
Under the current healthcare law, Medicare and most private insurers would
be required to cover the entire cost of weight-loss services that meet or
exceed the task force's standards.
That could all change Thursday, when the U.S. Supreme Courtis expected to
rule on the constitutionality of President Obama's healthcare law, which
requires adoption of certain recommendations from the task force, such as
this one on obesity.
Few private health insurers now reimburse physicians for weight-loss
counseling or pay for programs that patients seek out on their own. A
growing number, in fact, charge obese patients more for coverage a
policy that some public health officials have denounced as punitive and
ineffective.
The task force concluded after a review of the medical literature that the
most successful programs in improving patients' health were "intensive,
multicomponent behavioral interventions." They involve 12 to 26 counseling
sessions a year with a physician or community-based program, the panel
said.
Successful programs set weight-loss goals, improve knowledge about
nutrition, teach patients how to track their eating and set limits,
identify barriers to change (such as a scarcity of healthful food choices
near home) and strategize on ways to maintain lifestyle changes, the panel
found.
In some cases, programs include exercise sessions as well.
The recommendation, published online in the Annals of Internal Medicine,
does not apply to the roughly one-third of Americans who are considered
overweight, those with a BMI from 25 to 29.9.
It follows a November decision by Medicare to reimburse physicians for
providing "intensive weight counseling" to the roughly 14 million obese
Americans insured by the government program.
The new guidelines were met with cautious support by many physicians on
the front lines of the nation's struggle against excess fat.
Dr. Jack Der-Sarkissian, a family medicine specialist at Kaiser
Permanente's Los Angeles Medical Center, called the guidelines a "long-
overdue" prod to physicians to help their patients control weight gain,
which raises the risk for diabetes, heart disease and other health
threats.
He cited a recent study that found that more than half of all obese
patients had never been told by their physician that they needed to lose
weight. "That's just not fair to the patient," said Der-Sarkissian, who
leads Kaiser's adult weight management efforts in Southern California.
"You have to diagnose the patient and have the discussion, even if the
patient doesn't really want to hear it," he said.
But Jeffrey Levi, executive director of the nonpartisan think tank Trust
for America's Health, said the recommendations would put physicians in a
difficult position: Few have the time or resources to provide obese
patients with intensive counseling, he said.
And since programs meeting the standards set by the task force remain
scarce, most doctors won't know where to send their obese patients.
"The question is whether the services will develop fast enough to meet the
potential demand," Levi said.
Susan Pisano, a spokeswoman for the trade group America's Health Insurance
Plans, said it was unclear how the report would affect the industry and
patients. But, she said, "there's a lot being done" already by health
insurers to help their enrollees lose weight.
Obesity and obesity-related diseases are already responsible for an
estimated $147 billion in annual healthcare spending. Widespread adoption
of the panel's recommendation would increase that spending, at least
initially.
The panel acknowledged that one problem with its recommendation was that
no studies have shown such intensive programs provide long-term health
benefits.
There appear to be short-term ones. Two studies cited by the panel found
that patients who received intensive counseling were 30% to 50% less
likely to have Type 2 diabetes two to three years later than those who
received lighter counseling, drug therapy or both.
But the counseling subjects' cholesterol numbers barely budged, and
changes in blood pressure and waist circumference were, on average, small.
A pilot program considered a model by the task force is now being launched
in 21 cities by the federal Centers for Disease Control and Prevention.
It is based on a clinical trial, the Diabetes Prevention Program, that
encouraged modest improvements in food choices and at least 150 minutes of
weekly exercise for participants, who were at high risk for developing
diabetes.
The subjects, who typically met weekly for six months and monthly for the
second half of the year, lost between 5% and 7% of their body weight and
reduced their diabetes risk by 58%.
***@latimes.com
http://www.latimes.com/news/nationworld/nation/la-sci-obesity-screening-
20120622,0,2815818.story