The alarm bells should be ringing in Congress: a disease that is already a leading cause of death for Americans is now projected afflict almost half of all adults in the next eight years.
The disease is obesity. For decades it was thought to be a personal moral failing. Science has shown that to be wrong, just as chemistry has shown that substance abuse is immune to “just say no.” Congress must act because body shaming cannot be a substitute for national health policy.
Today, more than 4 out of 10 American adults have obesity, from 3 in 10 in 2000. Those defined as severely obese rose even faster, from about 1 in 20 to 1 in 10.
obesity kills 300,000 Americans annually, and poor nutrition is the main risk factor of mortality in the US Obesity is also an underlying condition in nearly a third of COVID-19 hospitalizations. It damages almost every system in the human body, leading to diabetes, heart disease, stroke, various forms of cancer, mental illness, difficulty with physical function, and many other diseases.
Amazingly, the medical establishment spent almost a quarter of a billion dollars in 2020 treating conditions where obesity was a major cause, but spent alarmingly little on preventing or treating obesity itself. Preventing obesity and obesity-related diseases not only eliminates unnecessary suffering and death, it also makes financial sense. A Bipartisan Policy Center 2022 The report co-authored by one of us concluded that obesity costs $248 billion (in 2020) in annual medical expenses, 6.2 percent of total expenses. A USC Schaeffer Center The health microsimulation model found that obesity is a greater risk to public finances than smoking.
Despite this, few treatments for obesity are covered by Medicare and private insurers. Currently, coverage is limited to behavioral counseling in primary care settings and weight loss surgery for people with severe obesity and related conditions, leaving most people with obesity with very few effective options.
more intensive behavioral counseling could help fight obesity, but Medicare falls short by limiting coverage to primary care providers who are rarely fully trained in weight management and do not have the time to provide prolonged interventions. Intensive behavioral counseling could be delivered more effectively, and potentially at lower cost, by specialist providers, including registered dietitians and psychologists. Medicare Coverage for Medical Nutrition Therapy — a type of nutritional counseling given by a registered dietitian — is also limited to people with diabetes or kidney disease, leaving attention to people with obesity and many other diet-related diseases.
When the Medicare drug benefit was created nearly 20 years ago, Congress banned coverage for weight-loss therapies on the grounds that they were cosmetic treatments, not health treatments. As usual, private insurers followed suit: Less than 10 percent of people Have commercial health insurance that covers weight control medications.
Despite the lack of incentives from Medicare, five drugs have hit the market that can reduce weight in 6-16 percent for 52 to 68 weeks. reducing only 5 percent of body weight improves blood sugar, blood pressure, triglycerides, HDL cholesterol, sleep apnea, and other chronic conditions. Drugs are safe and important tools for the health of Americans, but they cannot significantly contribute to the battle against obesity without insurance coverage.
Bipartisan bills in Congress aim to solve the problem.
the Obesity Treatment and Reduction Act (TROA) was introduced by Sens. 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.). It would expand Medicare coverage to include FDA-approved prescription drugs for chronic weight control and intensive behavioral counseling provided by registered dietitians and other specialists.
Another bipartisan bill, the Medical Nutrition Therapy Act, was introduced by Sens. 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 conditions and allow a variety of professionals to refer the service.
Beyond access to medication and nutritional counseling, bipartisan political leadership is needed to advance policies that improve nutrition security for all. In the U.S, childhood obesity is more common than childhood hunger, even in low-income households. The Child Nutrition Reauthorization —which includes the National School Lunch Program and the Special Supplemental Nutrition Program for Women, Infants, and Children, among other programs— it should happen with a view to combating childhood obesity by improving food and nutritional security. In addition, the reauthorization of the Farm Bill by the upcoming 118th Congress will provide an opportunity to raise the quality of the diet as part of SNAP (Supplemental Nutrition Assistance Program), known as the “food stamp” program.
Medicare and private insurers pay for treatment for diabetes, heart disease, and high blood pressure. If saving lives is the goal, then logic, clinical evidence, and compassion dictate that they must also pay to prevent and treat obesity, starting now.
Anand Parekh is a board-certified internal medicine physician, chief medical advisor to the Bipartisan Policy Center, and former Deputy Assistant Secretary for Health at the US 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.
