Obesity Considered ‘Disease’ for Medicare Purposes

Published September 1, 2004

U.S. Health and Human Services (HHS) Secretary Tommy Thompson announced on July 15 that the Centers for Medicare & Medicaid Services (CMS) would remove from its Medicare coverage manual language saying obesity is not an illness. The move ends a longstanding HHS position that obesity is predominantly a result of lifestyle choices and opens the door for millions of overweight Americans to make medical claims for treatments such as stomach surgery and diet programs.

The significance of the move was noted by John C. Goodman, president of the National Center for Policy Analysis. “The problem with recognizing obesity as a disease is that it assumes medical intervention is the accepted protocol to treat excess weight. Yet most physicians consider behavior modification, such as a sensible diet and regular exercise, as the best way to prevent obesity and its associated health risks.”

Medicare to Review Treatments for Obesity

Thompson told a Senate panel in July, “Obesity is a critical public health problem in our country that causes millions of Americans to suffer unnecessary health problems and to die prematurely. Obesity-related illnesses result in billions in health-care costs.”

“With this new policy,” said Thompson, “Medicare will be able to review scientific evidence in order to determine which interventions improve health outcomes for seniors and disabled Americans who are obese.” Beneficiaries will be able to request a government review of medical evidence to determine whether a treatment they are considering to address obesity would be covered under Medicare.

Though Medicare and Medicaid programs cover obesity-related medical problems–including Type 2 diabetes, cardiovascular disease, several types of cancer, and gallbladder disease–weight loss therapies were not covered under the previous HHS policy.

Thompson said the policy change is not expected to alter Medicare coverage immediately. Representatives of CMS, which oversees Medicare, said the agency may meet this fall to review scientific evidence on various surgical procedures related to obesity.

HHS officials have not made public any details on which obesity treatments are expected to qualify for coverage. Some likely candidates, however, are diet programs, psychological counseling, and stomach surgeries, according to HHS. No weight-loss drugs will be included in the new benefit, but the American Obesity Association, an advocacy group, plans to push for such coverage when Congress next addresses Medicare’s prescription drug coverage plan.

“Exaggerated Fear” of Obesity

University of Colorado law professor Paul Campos, author of The Obesity Myth, contends the media are feeding misinformation about obesity to the public, leading Americans to believe the country faces a national fat epidemic. “We have a tremendously exaggerated fear of higher than average weight in this culture,” said Campos.

Michael Fumento, senior fellow of the Hudson Institute in Washington, DC and author of the first book warning of America’s growing weight problem, The Fat of the Land: The Obesity Epidemic and How Overweight Americans Can Help Themselves, said, “The problem is the nature of the beast itself, the intractability of obesity. If preventing or treating it were as simple as regularly taking long walks and keeping your mouth shut, as Rick Berman of the Center for Consumer Freedom told a reporter, two-thirds of us wouldn’t be overweight.”

Fumento also said, “On the other hand, personal responsibility cannot be ignored. After all, somehow a third of us have managed to stay thin. While Big Food encourages gluttony, I’ve yet to see a Keebler elf threaten somebody’s life if he didn’t down another E.L.Fudge Peanut Butter Double Stuffed Sandwich Cookie.

“This,” said Fumento, “is just an opportunity for the diet industry to get fatter, for the already-anorexic Medicare fund to grow even thinner, and for fat seniors to remain fat seniors.”

Goodman noted, “Having Medicare cover obesity-related treatments will likely result in some people abandoning weight loss programs in favor of a quick fix. In the long run this will not only burden taxpayers but harm patients, who will not receive positive benefits from maintaining a healthy lifestyle.”

Increase in Weight-Loss Surgeries Likely

The change in Medicare’s obesity coverage policy received a warmer reception from firms in the obesity treatment industry.

“We see this as a tremendous opportunity,” Dan Cohen, vice president of Inamed, told the New York Post’s online edition. Inamed makes the “lap-band system,” a minimally invasive surgical treatment for morbid obesity. “The biggest challenge to us has been the reimbursement issue.”

At an approximate cost of $20,000 each, roughly 15,000 lap-band treatments were performed in the United States in 2003, Cohen estimated. If Medicare covered lap-band surgery, “there would certainly be a ramping up of that number,” he said.

Dr. Karen E. Gibbs, a bariatric surgeon at Montefiore Hospital in New York, agreed there is demand for the surgery. Gibbs told the New York Post, “We get calls from a fair number of Medicare patients–about 20 per month–who are prevented by insurance from having the operation done. A change in policy could increase access for them.”

Conrad F. Meier ([email protected]) is managing editor of Health Care News.