Medicare covers treatment for diabetes, hypertension, and heart disease. All are costly to the health care system – and all often have their roots in a larger problem.
“Often times a lot of the conditions that we treat are affected by obesity or associated with obesity,” said Dr. Ayaz Virji, a bariatric and family medicine physician based in Camp Hill, Pa.
Medicare now covers obesity counseling by primary care providers – doctors, nurse practitioners and physician assistants. Many herald the move as a paradigm shift. Until eight years ago, Medicare said obesity was not a disease.
“Now that [Medicare] has extended coverage, we can now hit into the heart of the matter and primary care doctors can address obesity more upfront and be compensated for it,” said Virji.
The new coverage puts the pressure on doctors and patients alike. Today about one-third of the 42 million Americans insured under Medicare are considered obese. The move will likely influence private insurers to follow suit with coverage.
But some people question how much of a game-changer this will be when it comes to combating this epidemic.
“I think a physician’s advice can be a very positively powerful influence in helping a person to realize that they need to lose weight,” said Dr. Rebekah Bernard, a family physician in Bonita Springs.
Under Medicare’s coverage, meetings with patients are weekly for the first month, then every other week for the next five months. If the patient loses at least 6.6 pounds during that time, Medicare will continue to cover the counseling.
Lack of reimbursement is a core obstacle for physicians to spend time on the issue with their patients. However, that may still be an issue for some providers.
“If you look at [Medicare’s] compensation for [obesity counseling], it averages to about $25 per visit – which is supposed to be an average of 15 minutes,” said Bernard.
“That reimbursement makes it a little bit challenging for the average physician, especially if they’re in a solo practice, to be able to really support themselves.”
But now that they are compensated, are providers up to the task?
A 2005 study by the Centers for Disease Control and Prevention found that only about 40% of obese people are actually advised by their healthcare professional to lose weight.
Gloria found that to be her experience.
The now petite Fort Myers woman is in Food Addicts in Recovery Anonymous. She struggled with her weight for more than three decades and weighed 197 pounds at her heaviest.
“I did notice that no physician, on his or her own, addressed the weight issue, no matter how I presented in the office, unless I specifically asked,” said Gloria.
“In my experience, physicians gave me the least support for losing weight, other than to just tell me that, yes, I could take off some weight when I asked if they thought I needed to.”
But Gloria acknowledges that doctors’ lack of involvement may be a product of frustration with patients.
“We all want to lose weight, but virtually none of us are willing to change our life styles,” she said. “Instead, we really want a magic pill that would do everything for us.”
Bariatric physician Ayaz Virji says providers may be reluctant for another reason.
“If you go to a patient and say, ‘Hey Mr. Jones, I want to address your weight today. Your BMI is 40 and that’s really influencing your blood sugar and blood pressure.’ Well, what’s Mr. Jones going to say? ‘OK, doctor, what do I do?’ That’s where it gets difficult,” said Virji.
“I think the burden is on the primary physicians and providers to now learn more about the management of obesity.”
And physicians like Dr. Rebekah Bernard are up to the challenge. She has started offering group-counseling sessions for her patients. Bernard based it off the Veterans Affair’s Move! Program, which is cited in Medicare’s decision memo to provide the obesity counseling coverage.
Patient Carol Koenig is one of six patients who has attended Dr. Bernard’s first two sessions. She’s taken other routes in her struggle to lose weight.
“Oh, I’ve gone to Weight Watchers. I go to Tops. I used to take diet pills…” she said.
But Koenig remains optimistic. She says losing weight with the help of her primary care provider changes everything.
“I think that’s great, because who knows better than she? What you should have? What should you weigh? She knows your cholesterol. She knows everything about you,” she said.
Koenig also adds, unlike other weight loss programs, this one is free.
