Should Federal Insurance Cover Obesity

July 19, 2004 -- By the time she was 17, Sheila Voorbach weighed well over 200 pounds.

The weight was rapidly pushing Voorbach toward Type 2 Diabetes. Fortunately, her family physician recommended a medication to curb her appetite.

There was one problem — since Medicaid didn't cover obesity treatments, just one bottle of the medication would cost her widowed mother, Monica, $150.

Voorbach started her daughter on the medication until she had lowered her weight to less than 200 pounds. But when Sheila began regaining the weight, "I just couldn't afford to put her back on the medication," Voorbach explains.

A policy change announced by U.S. Department of Health and Human Services (HHS) last Thursday may change all that. Now Medicare and Medicaid could help Voorbach beat her weight and hopefully deter diabetes.

The mother and daughter are not alone in thier plight. For the 75 million Americans on Medicare and Medicaid, this news could be life-changing.

Medicare and Medicaid are designed to cover necessary medical expenses for those who are eligible for federal insurance. In the past, the program manuals have stated that obesity was not an illness, and therefore, obesity treatments would not be reimbursed.

HHS Secretary Tommy Thompson announced that the program would remove that clause, possibly opening the door to obesity treatments for low-income Americans.

For Voorbach, who worries about her daughter getting diabetes, this might be a dream come true.

The new program would "help me out a lot," she says. "With it, [Sheila] will have a better chance to avoid the disease."

Weighing In On Policy

The policy change could allow reimbursements for obesity treatments such as gastric bypass surgery (also known as stomach stapling), exercise and nutritional counseling, and possibly even medications that help people lose weight.

Voorbach's family physician, Dr. Arlene Brown, who practices medicine in Ruidoso, N.M., says she believes the potential addition of obesity treatments covered under Medicare and Medicaid would significantly help her patients keep their weight under control.

Two-thirds of Brown's patients are Hispanic or Native American, two groups with very high risk for obesity.

"By allowing us to go ahead and treat [obesity]… we can be much more efficient," says Brown. "Before the ruling, you couldn't be paid to do this, and there's only so much of [free counseling] that you can do before you have to stop."

While Brown will not drastically change her practice, if the policy comes into effect she will be more able to offer more diet and exercise counseling for her patients.

"In the case of pre-diabetic children," she adds. "It's often helpful to work as a team with the child and parent to try and prevent this … the new policy could help me to do that."

Her sentiment is echoed by the American Dietetic Association (ADA). "ADA believes strongly that nutrition assessment, counseling and intervention by expert dietetics professionals is the best long-term strategy for prevention and treatment of obesity," ADA spokeswoman Katherine Tallmadge says.

Before the HHS announcement, government efforts for prevention were often left on the back burner. According to Dr. Dean Ornish, founder and president of the Preventive Medicine Research Institute, and a medical professor at the University of California in San Francisco, 75 percent of the $1.8 trillion spent last year on health care in the United States was for treatment of chronic illnesses, including heart disease, cancer, obesity, and diabetes. However, less than 2 percent of the total was spent on prevention of such diseases, he says.

While most efforts under the policy will probably focus on obesity treatment and prevention, Dr. Barbara Schuster, professor and chair of the Department of Internal Medicine at Wright State University in Dayton, Ohio, additionally hopes that the changes could make medical counseling for obesity both economically friendly and more socially acceptable.

"The biggest effect [would] be the ability to code a visit "obesity" and have the visit charge reimbursed," she says. "That way, my patients can feel more comfortable coming in to discuss and be educated for this problem. We know that 'tobacco abuse' is a reimbursable code. Finally obesity will be."

Is It This Simple?

While doctors like Schuster are pleased by the change, not everyone is.

"This can only be viewed as a temporary fix," says Michael Nischan, author of Taste, Pure and Simple, a healthy recipe guide, and the president of Sources and Resources, a group looking for healthy solutions for the food service industry.

"The solutions are far more complicated to address than through overly simplified and partial solutions like providing medical coverage for obesity," he adds.

Similarly, Dr. John Messmer, an associate professor at Penn State College of Medicine in Palmyra, Pa., says that "obesity is a disease, but it's like substance abuse."He continues: "It requires insight into the problem and the will to do something about it — to change the way one deals with food."

Messmer is not convinced that HHS will be able to cope with the financial burden created by the nearly two-thirds of Americans who are overweight:

"How is the government going to spread the limited funds to include obesity surgery?" he asks. "I agree with the philosophy but I am suspect of the method they [might] use."

Should All Americans Foot the Bill?

While many doctors have shown their support for the expansion, the decision has prompted conservative groups around the country to speak out against the inclusion, saying that every American shouldn't have to pay for treatment of "preventable" obesity.

Radley Balko, a policy analyst at the Cato Institute, a Washington, D.C.-based libertarian think tank, says of the inclusion: "Obesity is not a disease. It's a condition that's both treatable and preventable, in most cases without drugs, doctors or hospitals."

"American taxpayers shouldn't be asked to foot the bill for the obesity problem," he adds.

While Dennis Avery, senior fellow at the Hudson Institute of the Center for Global Food Issues in Churchville, Va., a group that researches and analyses agricultural and environmental issues, supports the addition over all, he includes a caveat: "The key will be focusing on successful obesity interventions and not turning this new policy into another route via which taxpayer's money is funnelled into the pockets of fad diet and nutrition practitioners," he says.

"The success record for such interventions is so far not very encouraging, with even the best obesity treatments having an extremely high failure and/or reversion rate."

The Center for Consumer Freedom, a non-profit group supported by the restaurant and food industries, moves one step further, suggesting that the "hysteria" over obesity is manufactured and driven by the "$40 billion weight-loss industry."

CCF Director Richard Berman says: "The pharmaceutical and weight-loss industry has manufactured an epidemic to have the cost of its weight-loss drugs and treatments underwritten by taxpayers."