Medicare to pay for obesity counseling sessions

By Dr. Ananya Mandal, MDNov 30 2011

The United States Medicare program for the elderly will cover counseling for obesity. Obesity rates have hit the highest in the past few years and this measure is an attempt to curb the epidemic.

Obesity can lead to a host of health problems and complications and is a leading cause of diabetes and heart disease. According to the STOP Obesity Alliance, the overall costs of being overweight over a five-year period are $24,395 for an obese woman and $13,230 for an obese man. Thirty-four percent of U.S. adults are obese, according to the alliance, which expects that percentage to rise to 50% by 2030.

The Centers for Medicare & Medicaid Services (CMS) said on Tuesday obesity counseling and screening has been added to its portfolio of preventive services. “Obesity is a challenge faced by Americans of all ages, and prevention is crucial for the management and elimination of obesity in our country,” CMS Administrator Donald Berwick said in a statement. “It's important for Medicare patients to enjoy access to appropriate screening and preventive services,” he added.

Screening for obesity and counseling for eligible beneficiaries by primary care providers are covered under the new benefit, CMS added. For those patients who are diagnosed to be obese based on body mass index measures, the benefit would include one face-to-face counseling visit each week for one month and one face-to-face counseling visit every other week for an additional five months. Medicare patients who lose at least 6.6 pounds (3 kilograms) during the first six months of counseling would be eligible to receive addition face-to-face counseling once a month for an additional six months for up to a total of 12 months of counseling, the agency said.

“This decision is an important step in aligning Medicare's portfolio of preventive services with evidence and addressing risk factors for disease,” Patrick Conway, the CMS chief medical officer, said in a statement.

“As small of a weight loss as 5% to 7% can lead to a huge health improvement,” said Christy Ferguson, director of the STOP Obesity Alliance, which sent recommendations to Health and Human Services Secretary Kathleen Sebelius in September.

Patrick O'Neil, president of the Obesity Society, a group of weight-control researchers and professionals, said the change recognizes the medical significance of obesity. However, it doesn't cover treatment provided by dietitians and psychologists.

Dr. Robert Eckel of the University of Colorado's medical school in Aurora, Colo., told MedPage Today in a phone interview that he was skeptical that the counseling to be provided would achieve major, lasting improvements in patients' health. “The question is sustaining the benefit” of successful weight loss beyond the first year, he said. He said his initial reaction was that the coverage is “more money [paid out of Medicare] without proven benefit.”