A provision of the Affordable Care Act requires that Medicare pay for obesity counseling by primary care physicians. The federal health insurance program for people 65 and older has long paid for costly treatments of some of the chronic diseases associated with obesity, such as diabetes and heart disease, but in what many viewed as a contradiction, Medicare refused to reimburse doctors for the work they did helping patients lose weight.
Under changed rules, seniors with a body mass index of 30 or more are able to receive weight-loss counseling from their doctor once every week for a month, then once every other week for five more months, and Medicare will cover the cost. If the patient loses 6.6 pounds, then Medicare will pay for bi-weekly visits for another six months after that. Approximately one third of seniors on Medicare are obese, and thus will be eligible for the counseling.
Doctor Lyle Bohlman of the University of Tennessee Medical Group, Inc. provides weight-loss counseling to obese seniors in Memphis, and Medicare is now reimbursing him for his efforts. “So, my counseling session would include helping people understand that reducing calorie intake is just a part of it, exercise is absolutely essential to losing weight,” Bohlman said. “I view it like a prescription, and I actually write it on a prescription pad.”
According to Bohlman, there’s a special challenge to doing this work with Medicare-eligible patients. “In older people, they have a fixed habit pattern that is a little more difficult to deal with probably than younger people,” he explained, “but I try to tap into the positives about that—you have more time that you can exercise, you’re not working 40, 50 hours a week like you used to.”
While studies have found the kind of clinical weight-loss counseling Bohlman is describing to be effective in helping individual patients lose weight, none of the coordinated efforts to halt the uptick in obesity in the United States have had their intended impact. In 2000, the obesity rate in the U.S. was about 30 percent. Today it is 35.7 percent, and a study by the Robert Wood Johnson Foundation projects that by 2030 the proportion of obese Americans will climb to 50 percent.
Bohlman points out that national efforts to cut back on smoking didn’t work right away either. “The Surgeon General’s report came out around 1960,” Bohlman said. According to Gallup, the number of adult American smokers hovered around 40 percent until the 1980s, when it dropped to 32 percent, and it wasn’t until well into the 21st century that the number fell to near 20 percent. “I think that [obesity is] the same kind of a complex behavioral problem that has to have societal input to put a dent in it,” Bohlman said.
Some surveys of physicians show that doctors feel unprepared to administer obesity counseling, and Bohlman echoes this sentiment. “The training has been, you know, minimal, because it has been such a discouraging issue,” Bohlman said. “Most physicians are very discouraged about treating obesity and they don’t feel they have good tools for that.”
Bohlman has been practicing for years and he says he is still not sure why his efforts work with some patients, and not with others. “We have to research what works with losing weight, not just the counseling, but what program do I [recommend],” Bohlman explained. “How do I facilitate exercise? How do I facilitate healthy diet?”
Still, he believes changes to Medicare’s reimbursement policy are a start. Ten years ago, Medicare didn’t even recognize obesity as a disease. “Generally if Medicare comes out with a statement and a position on something, others insurers tend to follow suit,” Bohlman said, “and that’s why it is important.”