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The US Has Made Remarkable Progress In Policy Recognition Of Obesity As A Disease



sharma-obesity-policy1While the debate about whether or not obesity merits being called a disease may still be discussed in lay circles (and, unfortunately, even amongst some so-called “experts”), there have been some remarkably forward-thinking policy decisions in the US, that should have long helped lay this “debate” to rest.

Here are just some of the policies supporting the idea of obesity as a disease passed by US legislators in recent past, as outlined in the article by Scott Kahan and Tracy Zvenyach published in Current Obesity Reports.

In 2002, the US Internal Revenue Service (IRS) explicitly stated obesity is a disease and codified the right to deduct medical treatment for obesity.

In 2004, the US Centers for Medicare and Medicaid Services (CMS) revised longstanding national coverage determination (NCD) policy that explicitly stated obesity was not an illness, to state that it was.

In 2006, CMS instituted coverage for certain bariatric surgical treatments for Medicare beneficiaries with BMI >35 and at least one obesity comorbid condition. However, the determination clearly states that surgery is only covered as part of treatment for obesity comorbid conditions, but treatment for obesity per se is not covered (that is, patients must have acceptable comorbid conditions, regardless of the extent of their excess weight).

In 2011, CMS declared intensive behavioral therapy, consisting of screening, nutrition assessment, and frequent behavioral counseling (as defined by 14 face-to-face interactions with a primary care provider over 6 months and up to 22 sessions over a year), as a covered service for Medicare beneficiaries with BMI >30.

The Affordable Care Act (ACA) included several provisions with implications for obesity-related care, most notably that USPSTF grade A and B recommended services must be covered, including intensive behavioral counseling for obesity—a grade B recommended service. Although this benefit is categorized as a preventive service, rather than disease treatment, this designation nonetheless benefits patients, as ACA designates USPSTF recommended services to be covered without cost or cost sharing (co-payments, co-insurance, or deductibles).

Between 2012 and 2015, the US Food and Drug Administration (FDA) Center for Drug Evaluation and Research (CDER) approved four medications for the chronic treatment of obesity. These were the first medications to achieve approval in more than a decade, and came on the heels of several disapprovals. Also notable, these medications were approved for long-term use, consistent with the concept of chronic disease management.

Additionally, in 2015 FDA Center for Devices and Radiological Health (CDRH) approved three minimally invasive medical devices for obesity treatment.

In March 2014, the US Office of Personnel Management (OPM) issued official guidance to the Federal Employees Health Benefits (FEHB) Program health insurance carriers to clarify its policy for obesity pharmacotherapy coverage. OPM specified that “excluding weight loss drugs from FEHB coverage on the basis that obesity is a ‘lifestyle’ condition and not a medical one or that obesity treatment is ‘cosmetic’- is not permissible.” Among other clarifications made in this guidance, this explicitly chastises attempts to circumvent addressing obesity as a medical condition requiring clinical treatment as indicated.

In addition to these policies, both the American Medical Association as well as the US National Institutes of Health have explicitly recognized obesity as a chronic disease.

Although the full impact of these policies on prevention and access to care for people living with obesity remains to be determined (I believe they will prove to be substantial), they do herald a change in thinking about the nature of obesity and the need for providing better behavioural, medical and surgical treatments to individuals living with this chronic disease.

@DrSharma
Edmonton, AB

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