Posts Tagged ‘costs’

Medicare Urged to cover Intensive Counseling

September 28th, 2011

As we announced before, the Centers for Medicare and Medicaid Services is evaluating   including intensive behavioral counseling for adults with obesity as a Medicare benefit. Below are comments we just filed with Medicare. (The comment period closes September 30, 2011)  Readers still have time to submit their own comments.

Sarah McClain, MHS
Lead Analyst
Coverage and
Analysis Group
Centers for Medicare and Medicaid Services
Mail Stop C1-09-06
7500 Security Boulevard
Baltimore, Maryland 21244-1850
 

Dear Ms. McClain,

 The proposed coverage of intensive behavioral counseling of adults for obesity is both indicated by its endorsement by the United States Preventive Services Task Force , subsequent literature, and two studies published in the last month.

 

The Look AHEAD study has focused on the benefits of lifestyle changes to achieve weight loss in overweight/obese participants with type 2 diabetes. The study population which received intensive lifestyle intervention (such as that contained in the proposed decision memorandum) obtained superior results to those receiving usual care (diabetes support and education.) At year 4, there was a 4.7% reduction from initial weight in the intensive lifestyle group compared to 1.1% in the usual care group. 46% of the intensive lifestyle group lost more than 5% of initial weight and 23% lost more than 10%. (The usual care group saw 25% lose more than 5% and 10% lose more than 10%.) 

As these results would predict, the intensive lifestyle group had significantly greater improvements in glycemic control and several markers of cardiovascular disease risk.  

As with the Diabetes Prevention Program, the study’s oldest participants, 65-74 years of age, lost significantly more weight than younger counterparts at all 4 years, and reported lower daily caloric intake, higher physical activity and overall greater adherence to the behavioral program. (Wadden TA, Neiberg RH, Wing RR, et al, Four-Year Weight Losses in the Look AHEAD Study: Factors Associated with Long-Term Success, Obesity (2011) 19;10: 1987-1996.) 

Thus, it appears that Medicare could ‘look ahead’ with some confidence that the proposed benefit can result in immediate health improvements to Medicare beneficiaries.

 

These health improvements can be economically quantified, although that is not necessary for the purposes of National Coverage Determinations. Recently, Dr. Kenneth Thorpe reported that a 10% reduction in weight in persons with obesity  age 60-64 could provide Medicare with savings of $1.8 to $2.3 billion over ten years and even more if overweight pre-diabetic adults were included. (Thorpe KE, Yang Z, Enrolling people with prediabetes ages 60-64 in proven weight loss program could save Medicare $7 billion or more. Health Affairs 2011 Sep; 30(9):1673-9)  While the study participants did not achieve the 10% criteria, their remarkable results indicate a significant cost saving to the Medicare program could be achieved.

For these reasons, the Centers for Medicare and Medicaid Services should not only implement the proposed decision memorandum for Medicare beneficiaries but to explore ways in which such intensive behavioral counseling for obesity may be utilized by as many obese beneficiaries as possible. This would include a two-prong educational campaign. The first prong would be directed to the appropriate health care professionals to make them aware of the benefit and how to achieve competency in intensive behavioral counseling. The other prong would be directed at Medicare beneficiaries to make them aware of the new benefit and possibilities of successful weight management.

 

 Sincerely,

Morgan Downey,

Editor & Publisher, Downey Obesity Report

Washington, D.C.

 

Severe Obesity’s Personal, Financial Toll

May 31st, 2011

Persons with severe or morbid obesity are hardly the lazy, indifferent people as they are often portrayed. Instead, as we see from this survey by the Canadian Obesity Network, they repeatedly try to lose weight in spite of frustrating disappointments, at great personal costs to themselves. They do not live in a bubble but realize the serious effects excess weight is causing in their careers, interpersonal relationships and self-esteem. Impact of Severe Obesity Felt Far Beyond Physical – Financial Burden and Emotional Implications Also Significant | Canadian Obesity Network

More on Costs of Obesity

October 4th, 2010

Eric Finkelstein and colleagues have published new data adding to the considerable literature about the economic costs of obesity. Using the 2006 Medical Expenditure Panel Survey and the National Health and Wellness survey, they estimated per capita medical expenditures and the value of lost productivity, including absenteeism and presenteeism. For men, the estimates  of excess costs ranged from under $322 for overweight men to $6, 087 for those with grade III (severe) obesity. For women, estimates of excess costs ranged from $979 for overweight women to $6,694 for those with grade III obesity. The aggregated annual costs attributable to obesity among full-time employees is $73.1 billion. Individuals with a body mass index of 35 or greater represented 37% of the obese population but 61% of excess costs. See The Costs of Obesity in the Workplace. [J Occup Environ Med. 2010] – PubMed result

Downey Fact Sheet 3 – Costs

September 27th, 2009

pdficon_small Printable PDF

New analysis indicates costs attributed to obesity are estimated to be $147 billion per year. Annual Medical Spending Attributable To Obesity: P…[Health Aff (Millwood). 2009] – PubMed Result In 1998 the medical costs of obesity were estimated to be $78.5 billion, approximately half financed by Medicare or Medicaid.National Medical Spending Attributable To Overweight And Obesity: How Much, And Who’s Paying? — Finkelstein et al., 10.1377/hlthaff.w3.219 — Health Affairs.

Total health care expenditures of obese adults increased by more than 80% from 2001 to 2006.

During this time, the proportion of health care expenditures for obese adults increased from 28.1% of total health expenditures to 35.3%.

The mean annual health care expenditure for obese adults increased from $3,458 in 2001 to $5,148 in 2006. AHRQ News and Numbers: Health Care Spending for Obese U.S. Adults Rose More Than 80 Percent From 2001 to 2006

Total health care costs attributable to obesity/overweight are projected to double every decade, accounting for 16-18% of total US health care costs. Will all Americans become overweight or obese? Will all Americans become overweight or obese? est…[Obesity (Silver Spring). 2008] – PubMed Result compared to about 9% at present.

Elevated BMI levels in children is associated with $14.1 billion in additional prescription drug, emergency room and outpatient visit costs annually, indicating that the economic consequences of childhood obesity are probably much greater than previously indicated. The Impact of Obesity on Health Service Utilizatio…[Obesity (Silver Spring). 2009] – PubMed Result.

Latest News

September 27th, 2009

October 21, 2009

FDA plans revision to nutrition label. FDA seeks to improve nutrition labeling on food products – washingtonpost.com

October 20, 2009

Women with obesity at risk for in vitro fertilization failure The Press Association: Obesity cuts IVF success – study

October 19,2009

Can anyone get insurance? Now an underweight girl is excluded. Underweight Girl Denied Insurance Coverage – Denver News Story – KMGH Denver

October 18, 2009

Washington Post columnist Robin Givhan address the Fashion industry and thinness in the culture.Robin Givhan on Fashion: Size of the Model vs. Size of the Customer – washingtonpost.com

Great Idea: solve obesity by making people taller. Idea Lab – Should a War on Shortness Be One of the Goals of Health Care Reform? – NYTimes.com

October 17, 2009

NYT reports on prospects for new drugs for obesity Arena, Orexigen and Vivus Are Chasing an Effective Diet Drug – NYTimes.com

Why can’t CDC find obese swine flu patients? Pneumonia, Susceptibility of Young Among Traits of Swine Flu – washingtonpost.com

October 15, 2009             

Family Physicians Ink deal with Coke Family Doctors Sign Educational Deal With Coca-Cola – NPR Health Blog : NPR

October 14, 2009

First Lady Michelle Obama tackles childhood obesity Michelle Obama’s Weight Loss Tips: Watch TV Standing Up — Politics Daily

North Carolina Plan criticized Obesity penalty isn’t fair or effective – Columnists/Blogs – News & Observer

Ralph Lauren model fired for being too fat Photoshopped Ralph Lauren Model Filippa Hamilton Fired For Being Fat – WPIX

Dr. Bernandine Healy hits punitive steps against the obese The Obesity Epidemic Isn’t Just About Willpower – US News and World Report

October 13, 2009

Candidate’s weight becomes important issue in NJ Governor Race Is Chris Christie Too Fat to Be the Next Governor of New Jersey? – The Gaggle Blog – Newsweek.com

October 12, 2009

Infant denied health care for  pre-existing conditions Why we need health-care reform: ‘Obese’ infant denied insurance!

Colorado Insurer caves The Associated Press: Colo. insurer changes course on fat infants

Baby denied health insurance for obesity as pre-existing condition 17-Pound, 4-Month-Old Baby Denied Health Insurance for Being Too Fat – Children’s Health – FOXNews.com

October 9, 2009

Groups push back on premium increases in Senate Finance Bill If Your Waistline Grows, Should Your Premiums, Too? – Prescriptions Blog – NYTimes.com

October 8, 2009

Corzine attacked as bigot Is Corzine A Bigot? | The New Republic

October 7, 2009

Physicians lead the way in treating obesity Doctors join fight against obesity – USATODAY.com

NJ Governor Corzine accused of attacking opponents weight Corzine Points Spotlight at Christie’s Weight – NYTimes.com

North Carolina to punish overweight state workers North Carolina state health plan to penalize smokers, obese

October 6, 2009

Study showing restaurant calorie labeling doesn’t change habits sure to add fuel to labeling debate Calorie Postings Don’t Change Habits, Study Finds – NYTimes.com

October 2, 2009,

New York Board of Education bans bake sales Bake Sales Are Banned in New York Schools – NYTimes.com

October 1, 2009

After 20 years USDA program for Women Infants and Children adds fruits and vegetables to its voucher program WIC nutrition program expands to cover fruits, vegetables — latimes.com

September 17, 2009 NEJM publishes study on taxing sugar-sweetened beverages NEJM — The Public Health and Economic Benefits of Taxing Sugar-Sweetened Beverages

September 11, 2009

Indiana Court allows workers comp coverage of bariatric surgery Indiana Appeals Court Affirms Work Comp Coverage for Obesity Surgery

September 9, 2009

STOP Obesity Alliance presents health care reform proposals Curbing Obesity Epidemic Key to Health Care Reform: Experts – US News and World Report See 16th and 17th U.S. Surgeons General, STOP Obesity Alliance Announce America has Reached Tipping Point on Obesity, Call for Direct Action – STOP Obesity Alliance

September 1, 2009

Institute of Medicine issues recommendations for combating childhood obesity Report maps out solutions to child obesity – USATODAY.com

USDA announces child nutrition grants Release No. 0416.09

More employers trying financial incentives As Federal Healthcare Reform Debate Continues, New Survey Reveals More Companies Turn to Financial Rewards to Tackle Soaring Employee Healthcare Costs

August 31, 2009

New target for therapies identified Study may lead to new obesity therapies – UPI.com

New York City targets sugar-sweetened drinks New Salvo in City’s War on Sugary Drinks – City Room Blog – NYTimes.com

Risk of infant mortality rises with mother’s weight Mom’s obesity tied to higher infant mortality

August 30, 2009

Obesity linked to swine flu deaths Obesity linked to swine flu deaths | World news | The Observer

August 27, 2009

Extreme obesity shortens lives by 12 years Extreme obesity can shorten people’s lives by 12 years – USATODAY.com

New drug claims ability to fight obesity and diabetes New fat-fighting drug has anti-diabetes action too | Health | Reuters

Obesity deniers come out http://www.newsweek.com/id/213807

August 24, 2009

American Heart Association raises alarm about sugar Heart Association recommends limits on added sugars – White Coat Notes – Boston.com

Interesting graph plots out contribution of obesity, age and health status on costs. A Concentration of Health Expenses – Prescriptions Blog – NYTimes.com

GE introduces new MRI geared for larger patients GE Healthcare shows off latest MRI – The Business Review (Albany):

Obesity a risk for swine flu deaths Half of swine flu deaths in high-risk people -study | Reuters

August 18, 2009

Sleep apnea on increase Sleep Apnea Rises With Obesity, Boosts Deaths in Middle-Aged – Bloomberg.com; PLoS Medicine: Sleep-Disordered Breathing and Mortality: A Prospective Cohort Study

Push back on doctor’s campaign against obesity Anti-Obesity Dr. Jason Newsom Chomps Down on Dunkin’ Donuts « Vitals Spotlight – We Give the Doctor an Exam

August 11, 2009

President Obama calls for health insurance reform to cover obesity treatments, stating, “All I’m saying is let’s take the example of something like diabetes, one of — a disease that’s skyrocketing, partly because of obesity, partly because it’s not treated as effectively as it could be. Right now if we paid a family — if a family care physician works with his or her patient to help them lose weight, modify diet, monitors whether they’re taking their medications in a timely fashion, they might get reimbursed a pittance. But if that same diabetic ends up getting their foot amputated, that’s $30,000, $40,000, $50,000 — immediately the surgeon is reimbursed. Well, why not make sure that we’re also reimbursing the care that prevents the amputation, right? That will save us money. Text – Obama’s Health Care Town Hall in Portsmouth – NYTimes.com

August 10, 2009

Nominee for Surgeon General attacked over body weight Does it matter what the doctor weighs? — latimes.com

Arena preparing to submit new obesity drug to FDA San Diego Business Journal Online – business news for San Diego, California

August 7, 2009

Recession could worsen obesity prevalence Recession could have negative impact on obesity levels | News | Nursing Times

July 17, 2009

Minorities, blacks hardest hit by obesity reports CDC Atlanta health, diet and fitness news | ajc.com

July 16, 2009

AHA: severe obesity increases risks in surgery Severe obesity increases risks of health problems during surgery

AHA: Clarity on the overweight mortality confusion Mortality, Health Outcomes, and Body Mass Index in the Overweight Range: A Science Advisory From the American Heart Association — Lewis et al. 119 (25): 3263 — Circulation

July 14, 2009

Excess weight speeds up osteoarthritis Excess Weight Speeds Up Osteoarthritis: MedlinePlus

July 14, 2009

RWJ releases report on taxes for sugar sweetened beverages Sugar-Sweetened Beverage Taxes and Public Health – RWJF

July 14, 2009 WHO addresses swine flu vaccine for persons with obesity. Swine Flu Vaccine Recommendations from World Health Organization – Health Blog – WSJ

July 10, 2009 CDC finds high prevalence of obesity in swine flu patients. Intensive-Care Patients With Severe Novel Influenza A (H1N1) Virus Infection — Michigan, June 2009

July 2009 Study finds insulin resistance in overeating lean humans for the first time. Short-term overeating induces insulin resistance i…[Mol Med. 2009 Jul-Aug] – PubMed Result

July 10,2009

The economy, stress and overeating Job Stress, Economy Weighing on Americans: MedlinePlus

June 24, 2009

Obesity: Africa’s Next Big Killer Africa’s newest silent killer: obesity | FP Passport

July 2, 2009

Connecticut Governor Vetoes Labeling Bill

Rell rejects nutritional labeling for chain restaurants – The Connecticut Post Online

July 1, 2009

Obama Address Obesity in Town HallObama Addresses Health-Care Reform at Virtual Town Hall Meeting – washingtonpost.com

July 1, 2009

Trust for America’s Health releases “F as in Fat 2009” http://www.rwjf.org/files/research/20090701tfahfasinfat.pdf

June 30, 2009

Institute of Medicine Issues Report on Comparative Effectiveness Research

Initial National Priorities for Comparative Effectiveness Research – Institute of Medicine

Read Morgan Downey’s Testimony

http://www.iom.edu/Object.File/Master/64/740/Speaker%20Testimonies%203-4PM%20b

lock.pdf

June 30, 2009

Oregon enacts restaurant labeling bill AP Wire – Oregon | kgw.com | News for Portland Oregon and SW Washington

June 29, 2009

More Data on surgery for diabetes Weight-Loss Surgery May Be Beneficial for Diabetes – NYTimes.com

June 29, 2009

Kentucky phasing out sugar sweetened beverages Congress May Look to Ky. Schools’ Healthy Example in Creating Nutritional Policy – washingtonpost.com

June 25, 2009

IOM release workshop on Food Desserts The Public Health Effects of Food Deserts. Workshop Summary – Institute of Medicine

May 28, 2009

IOM Releases report on Weight Gain in Pregnancy Report Brief. Weight Gain During Pregnancy: Reexamining the Guidelines – Institute of Medicine

May 9, 2009

Do obesity related diseases predispose to swine flu severity? Other Illness May Precede Worst Cases of Swine Flu – NYTimes.com

Federal Government

September 27th, 2009

Federal Programs on Obesity

For an excellent overview, see http://www.stopobesityalliance.org/research-and-policy/research-center/gw-research/ and F as in Fat: How Obesity Policies Are Failing in America 2008 – RWJF

National Institutes of Health

NIH is the preeminent research organization in the United States and the world and have a number of research programs related to obesity.

Weight Information Network has many fact sheets, also available in Spanish Welcome to WIN – The Weight-control Information Network

What is NIH spending on obesity? A projected $664 million. NIH Research Portfolio Online Reporting Tool (RePORT) – Estimates of Funding for Various Research, Condition, and Disease Categories (RCDC)

What are the specific grants now in process? NIH Research Portfolio Online Reporting Tool (RePORT) – RCDC Project Listing by Category

What is their plan to address obesity? Obesity Research at the National Institutes of Health (NIH)

Information on applying for grants. http://grants.nih.gov/favicon.ico

Clinical trials Home – ClinicalTrials.gov

Some particular projects:

Longitudinal Assessment of Bariatric Surgery Longitudinal Assessment of Bariatric Surgery

Clinical Nutrition Research Units WIN – Research – ONRCs and CNRUs

Research Opportunities Obesity Research at NIDDK : NIDDK

Advisory Groups Clinical Obesity Research Panel (CORP) : NIDDK

NIDDK Office on Obesity Research Office of Obesity Research : NIDDK

Look Ahead Trial Action For Health in Diabetes (Look AHEAD) : NIDDK

Food and Drug Administration (FDA)

The FDA has several responsibilities when it comes to obesity, including nutrition labeling and approval of drugs and devices

Calories Count: The 2004 plan of FDA to address obesity FDA/CFSAN – Calories Count: Report of the Working Group on Obesity Q&A Questions and Answers – The FDA’s Obesity Working Group Report

The Keystone Report on Away from Home Foods Calories Count and Keystone Report

Consumer information on reading the nutrition label. Make Your Calories Count

Department of Agriculture

Women Infants Children program of the USDA is a program of providing grants to states for nutrition education and support for low income pregnant, breastfeeding or post partum women WIC

Food and Nutrition Information Center Food and Nutrition Information Center

General Information on obesity General Information and Resources : Weight and Obesity : Food and Nutrition Information Center

Consumer Nutrition Information Weight Management : Nutrition.gov

Internal Revenue Service (IRS)

While the IRS is not considered a health agency, it does provide that taxpayers may use the medical deduction for expenses related to weight loss when a physician makes a recommendation of weight loss. Publication 502 (2008), Medical and Dental Expenses

Surgeon General

Surgeon General Richard Carmona on Obesity The Obesity Crisis in America

Surgeon General’s Report to Prevent and Decrease ObesityThe Surgeon General’s Call to Action to Prevent and Decrease Overweight and Obesity

Transcript of meeting where Surgeon General David Satcher decided to issue Surgeon General’s Report on Preventing and Overcoming Obesity: http://www.health.gov/hpcomments/council4-23-99/focus.htm

Earlier Surgeon General Reports on Nutrition and Health The Surgeon General’s Report on Nutrition and Health (1988) and Physical Activity Physical Activity and Health Executive Summary

Center for Medicare and Medicaid Services (CMS)

In 2004, CMS dropped language from its policies that obesity was not considered a disease. 2004.07.15: HHS Announces Revised Medicare Obesity Coverage Policy. A Deletion Opens Medicare To Coverage for Obesity – The New York Times

Subsequently, it convened an advisory panel to consider expanding or restricting medicare coverage of bariatric surgery which considered a summary of the evidence on the surgery’s safety and effectiveness. http://www.cms.hhs.gov/FACA/downloads/id26c.pdf

The outcome of the advisory panel was very favorable and, in 2006, official coverage policy was changed and expanded. Centers for Medicare & Medicaid Services

Disability

EEOC Policy on obesity EEOC Informal Discussion Letter

EEOC definition of “disability” Section 902 Definition of the Term Disability

6th Circuit Court of Appeals denies ADA claim based on morbid obesity. Read the full decision in EEOC v. Watkins Motors. http://www.ca6.uscourts.gov/opinions.pdf/06a0351p-06.pdf

Through the Social Security Administration, individuals who are morbidly obese and have cardiovascular, respiratory or musculoskeletal problems may quality for disability.

See: Disability Doc – Examining Social Security Disability – Obesity and Disability

Centers for Disease Control and Prevention (CDC)

The CDC has numerous fact sheets and guides. Where appropriate, they are incorporated into more specific sections of the site.

To see all the CDC resources available, go to Obesity and Overweight: Topics | DNPAO | CDC

Agency for Healthcare Research and Quality (AHRQ)

AHRQ funds research, especially on the translation of basic research into clinical practice, improvements to clinical care and a number of evidence-based guidelines. Relevant guidelines are included in the treatment or health effects sections. AHRQ is a leader in Comparative Effectiveness Research and obesity is one of their major conditions of interest.

See Agency for Healthcare Research and Quality (AHRQ) Home Page

Medicaid

Morbidly obese patients often return to work after gastric bypass surgery Return to work after gastric bypass in Medicaid-fu…[Arch Surg. 2007] – PubMed Result

Veterans Administration

Learn about the VA programs in weight management at MOVE! Home

Department of Defense

Information on the military’s Tricare program and weight management can be found at The TRICARE Blog