Monday, February 23, 2015

Medicare and Obesity

The ACA has allowed Primary Care physicians to get fully reimbursed for counselling Medicare Patients who are obese. Kaiser has a piece discussing its lack of success. They state:

For older adults, being mildly overweight causes little harm, physicians say. But too much weight is especially hazardous for an aging body: Obesity increases inflammation, exacerbates bone and muscle loss and significantly raises the risk of heart disease, stroke, and diabetes....o help the 13 million obese seniors in the U.S., the Affordable Care Act included a new Medicare benefit offering face-to-face weight-loss counseling in primary care doctors’ offices. Doctors are paid to provide the service, which is free to obese patients , with no co-pay. But only 50,000 seniors participated in 2013, the latest year for which data is available....who is obese herself, says she doesn’t expect her older patients to lose a lot of weight. “I think you’ll see weight loss of 10 to 20 pounds, but whether you’re going to see people lose 50 to 100 pounds as they’re older, I doubt it.”. Still, ... says, even with small amounts of weight loss in her older patients, she expects to see a decrease in the complications of chronic medical diseases, including diabetes-related leg amputations.

The facts are:

1. Obesity is an inflammatory enhancing state. Inflammation enhances the potential for and the exacerbation of various cancers.

2. Ongoing obesity has multiple sequella including costly kidney and cardiovascular problems.

3. Yes, Primary Care physicians have problems communicating with patients and worse patients just do not listen. Look at the number, 13 million obese Medicare patients and only 50,000 were dealt with, not necessarily successfully.

 The problem of obesity starts young and then continues. Why not stop it in the teenage years? Why not before 40? Why wait until 65 and later. The costs of obesity on future generations will be explosive. The ACA may have had good intentions but adherence demands perhaps a heavy hand.