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How Health Reform Will Help Us Lose Weight

By Dr. Jennifer Lee

Regardless of your opinions about health reform, you’ll likely agree that one of the major public health problems in the US is the dramatic rise in obesity.  More than 32% of American adults are obese and more than 17% of children and adolescents are overweight.[1]  Why should we be concerned about these trends?  Obese individuals are more likely than normal-weight individuals to develop chronic diseases such as hypertension, heart disease, diabetes, and stroke.  The increase in obesity and its health consequences is straining our health-care system.   In 2000, the total cost of obesity in the United States was an astounding $117 billion—$61 billion in direct costs and $56 billion in indirect costs.[2]   These costs are shared by everyone-- through increased health care spending on obesity-related medical problems and by losses in worker productivity.

 Physicians know how hard it is to tackle the difficult problem of obesity in a 20-minute office visit.  Urging patients to exercise and to make healthier food choices once every three months might help encourage those patients who are already committed to losing weight.  But for many patients, it is not enough.  Anyone that has struggled to lose weight knows that the social, economic, and behavioral factors leading to obesity are too complex and deep-seated to be adequately addressed in one brief doctor visit.  Instead, what if doctors could refer obese patients to a weight loss program that involved ongoing intensive counseling and behavioral intervention?  (Programs that include diet, exercise, and behavioral therapy have been proven to lead to sustained weight loss).[3]  And what if the cost of the intensive counseling and behavioral weight loss program would actually be covered by the patient’s insurance plan—without any additional out-of-pocket costs to the patient?

 Would you consider this a reasonable way to begin to address the difficult problem of obesity in America?  Policymakers did too.  According to the new health reform law, if you or your family enrolls in a new health plan on or after September 23rd of this year, the plan will be required to cover recommended preventive services without any additional co-pays, co-insurance or deductibles for those services.[4]  “Intensive counseling and behavioral interventions” for obese adults is one of these included services.[5]  Other services include smoking cessation programs, cholesterol and diabetes screening, and screening for common cancers.  Beginning January 1, 2011, Medicare enrollees will have the same access to recommended preventive services without cost-sharing.  States that offer this same benefit through their Medicaid programs will receive enhanced federal funding.

 Will this make a difference?  Researchers from Virginia Commonwealth University found that offering free obesity and smoking cessation counseling services generated tremendous patient interest in these programs.[6]   Patients who had deferred counseling in the past were motivated to enroll.  Care providers were also sensitive to changes in coverage.  Doctors and nurses were much more likely to discuss health behaviors and refer patients when free counseling was available. 

 Requiring insurance companies to cover preventive care is just one way the Affordable Care Act targets the problem of obesity.  The law also invests in health education; creates new grants to develop healthier schools and workplaces and promote healthy eating and physical fitness. It also requires chain restaurants and vending machines to provide nutrition information about food items they sell.

 Tackling obesity makes sense.  Reducing obesity in the US will not only save lives, but will also improve economic productivity and reduce health care costs related to the complications of obesity.  Although we often talk about obesity, the Affordable Care Act is the country’s first major investment in programs and interventions that have been empirically shown to reduce obesity.  If we’re committed to improving the health of Americans, we need to see these programs through to implementation.

[1] Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of overweight and obesity in the United States, 1999–2004. JAMA 2006;295:1549-55.

 [2] Wolf AM, Colditz GA. Current estimates of the economic cost of obesity in the United States. Obes Res 1998;6:97-106.

 [3] U.S. Preventive Services Task Force. Screening for obesity in adults: recommendations and rationale. Ann Intern Med 2003;139:930-2

[4] Patient Protection and Affordable Care Act, Sections 1001, 4001-4205


[6] Krist AH, et al. Patient costs as a barrier to intensive health behavior counseling. American Journal of Preventive Medicine 2010;38:344-8.

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