Targeting Obesity With Health Care Reform

The Medicare Board of Trustees just released its latest report on the program’s finances and the results are terrifying. Despite a decline in health care costs, the Medicare Trust Fund will be bankrupt in 2026.

For the program to survive for future generations, innovation will be essential. The old medical paradigm of diagnosing and treating diseases must give way to a more holistic approach aimed at eliminating risk factors that lead to disease. The best place to start is by addressing the growing problem of adult obesity.

In the past 30 years, the percentage of American adults who are obese has doubled, driving a sharp rise in such chronic conditions as diabetes, heart disease and hypertension.

The ramifications for health spending are significant. Annual health costs for obese individuals are more than $2,700 higher than for non-obese people. That adds up to about $190 billion every year. And many of these costs are borne by Medicare, which will spend a half-trillion dollars over the next decade on preventable hospital readmissions alone.

We cannot afford to wait until patients are on Medicare to fight obesity. Rather, we need to encourage weight control over the course of patients’ lives.

Fortunately, we now have an ideal opportunity to implement reforms. The new health insurance exchanges created under the Affordable Care Act can establish effective care coordination strategies to identify and treat chronic conditions earlier, addressing not just the immediate conditions but the underlying ones as well. Obesity is one of the most common. Medicare, in turn, can adopt these strategies, and the benefits for both patients and taxpayers will be substantial. We may not be able to “cure” obesity, but even making small amounts of progress can yield big results. A 5%-10% loss of body weight can lower risk for heart disease and other killers. For obese patients, even a modest weight reduction can have significant health benefits. An 11-pound reduction in weight leads to a 58% decreasein the chance of developing diabetes. Even just losing two pounds reduces the risk of diabetes by 16%.

Currently, there is no obesity care coordination in Medicare services. Medicare generally covers bariatric surgery for morbidly obese patients, but the program offers little for those whose weight problem is not yet so severe. For example, it does not cover obesity medicines, despite clinical evidence that pharmaceutical treatment can result in significant weight loss.

Comprehensive care coordination must entail extending Part D coverage to include weight loss drugs. We know that these drugs are effective at helping patients shed extra pounds.

In both the health care exchanges and among Medicare recipients, we need to give physicians and patients as many tools as possible to combat obesity.

Some patients can lose weight and keep it off just by changing their diet and increasing their exercise. Others respond to a combination of pharmaceuticals and lifestyle management. Still others need surgical options to conquer obesity. Widening the range of effective treatment options could save Medicare $15 billion annually.

By 2020, half of all Americans are likely to suffer from one or more chronic diseases, a majority of them weight-related. We simply cannot “bend the cost curve” to control health care spending without addressing Americans’ weight. To do that, we need all treatment options on the table.

Tommy Thompson, a former governor of Wisconsin, served as the U.S. secretary of Health and Human Services from 2001-2005. Kenneth Thorpe, Ph.D. is professor and chair at the Rollins School of Public Health at Emory University. Both serve on the Partnership to Fight Chronic Disease. This originally appeared in USA Today on June 15, 2013.

19 replies »

  1. Obesity can be caused by:
    Eating more food than your body can use
    Drinking too much alcohol
    Not getting enough exercise
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  2. Obesity is now declared a disease! If so, it is a disease of affluence and most people afflicted by it, are obsessed about the difficulty of losing weight, whereas I believe the solution is quite simple.

    As a kid I grew up in New Zealand during the 2nd world war, when food was scarce and rationed. I remember only 2 kids at primary school who were overweight. One lived on a farm and ate dairy and other foods which were obviously not rationed or at least, were hard to ration by the authorities. The other had no interest in physical activity, but loved eating, particularly fatty fried food. Overweight adults were a rarity, as they are still in poorer societies.

    I walk along the streets of Balmain in Sydney after schools are out and most kids are eating ice creams, or consuming sugary drinks, bought for them by their mothers! When I grew up, the standard of living was much lower, but an ice cream or lemonade was a special treat, bought for me rarely.

    Today, in the 1st World, the majority of adults are overweight, many grossly and hideously obese. During my frequent business trips to the USA in the nineties, I was taken once to dinner by an obese company representative to Ur Cooks in Houston, Texas, where we selected our own steaks, cooked them and added cooked vegetables. The concept was ideal for feeding yourself a healthy nutritious meal. My host selected an enormous steak about 2 inches thick, covering most of his plate, cooked it and added copious vegetables that almost fell off his plate. I selected the smallest steak available – still large in my view, added vegetables, ate my meal, feeling I probably could have eaten more, but pleasantly satisfied.

    The answer to obesity is common sense. If anyone is overweight, they must stop being be so greedy, but select nutritious food of a quantity that doesn’t make them feel (and look like) like a stuffed pig.

    Most obese people blame everyone but themselves – they have tried everything, they say – their genes are wrong (if so, they are lucky, they have an efficient metabolism and don’t need much food to remain functioning and healthy – would have been great in the ‘hunter/gatherer’ days) – they love sweet things – fast food is so tasty (lots of salt and fat!). There were no fat people in those horrendous concentration or POW camps during the 2nd world war.

    Has old fashioned, self discipline just gone out the window? For goodness sake, can’t humans stop putting food in their mouths! They don’t need a fad diet. In the blog on my site, ‘Lose Weight’, (See http://fitnessforum.us), I specify how to live a life that will banish obesity – to live longer and enjoy the years much more – obese people must simply resolve themselves NOW – only they can do it and it is simple.

  3. Why does all of this all look at Medicare and not mention strategy options for Medicaid? By the time the person is on Medicare the damage from perhaps a lifetime of morbid obesity is likely done.

  4. Thanks for sending that reference, I was unaware of it. Other studies have shown different results though.

    I guess some of this may depend on what “obese” means. If someone is mildly overweight, there is not much of a penalty. But as the degree of obesity increases, the life span decreases as well.

    You could be right for the moderately obese. I believe the story is different for the severely obese.

    In any case, it is certainly worthwhile trying to help people lose weight – for their benefit. Just don’t be looking for the pot of gold at the end of the rainbow.

  5. Not all the “studies”.


    “For years researchers suspected that the higher medical costs of obesity might be offset by the possibility that the obese would die young, and thus never rack up spending for nursing homes, Alzheimer’s care, and other pricey items.

    That’s what happens to smokers. While they do incur higher medical costs than nonsmokers in any given year, their lifetime drain on public and private dollars is less because they die sooner. “Smokers die early enough that they save Social Security, private pensions, and Medicare” trillions of dollars, said Duke’s Finkelstein. “But mortality isn’t that much higher among the obese.””

  6. 7 years of non-obese, non-smoker collecting Social Security and Medicare. Other studies that have looked at total costs have come to the same conclusion.

  7. Did you hear the joke about the career politician and industry insider who concoct a plan to stem the consequences of obesity in the Medicare population? Yeah, they want to diagnose more people, push more people to see their doctor, broaden the range of therapeutic options, and they claim that spending more money will actually cause us to spend less. Eventually. If people live long enough. Not very funny, is it? It never is when logic and common sense lose out to dogma. (Yes, this is the same Washington-centric math model that leads politicians and bureaucrats to claim that a reduction in the rate of growth of a government program is a cut.)

    While many Americans hitting 65 are unfit and have multiple comorbidities, CDC reports that almost half of them rate their personal health as good or excellent. Further, half of obese people are still metabolically healthy, and improved fitness will do far more for their long-term health (and the health of those with extant illness) than will swallowing a noxious weight loss drug, enduring its side effects, and seeing their doctor more often to manage same.

    It will prove incredibly difficult for Medicare to force a change the trajectory of the health lives of beneficiaries except at the margins; the change, if it comes at all, must come outside the clinic, so that the person requires fewer medical care resources in sum, and not just engage in a type shift that engenders a different kind of dependency on doctors, hospitals, and drug companies. The exception to this is in the ACO framework; any ACO that does not have a plan for improving the lifestyle habits of its Medicare beneficiaries is missing its greatest opportunity to contain costs and improve lives.

  8. Legacy, you’ve punched in your own numbers based on mythical person.

    7 years of non-obese, non-smoker paying into the consumption economy.

  9. I agree that waiting for Medicare to stop the obesity epidemic is kind of stupid. Taking steps to lead a healthy life should not be mutually inclusive with health care. Besides, beliefs like “junk food is cheaper than veggies and fruits” is just not true.

  10. Very well written.

    Obesity has turned to be life threatening for people and increasing medical cost adds to it.
    As mentioned it would be beneficial if we start controlling obesity during our course of lives rather spending a huge amount later in the life.

  11. There are provisions in the HELP bill and the House bill that support public health programs to combat chronic diseases, many of which are exacerbated by obesity.

  12. Peter 1,

    Just for fun, construct a spreadsheet of costs for two different people; one a non-obese, non-smoker and the other either obese or a smoker.

    Assume that the obese or smoker lives to age 70 or 75. Assume that the non-obese, non-smoker lives 7 years longer. Add $2,700 per year to the cost of the obese or smoker from age 40 to death. Then add the cost of Social Security, Medicare and several years of long term care to the non-obese, non- smoker for 7 years. See what you come up with.

  13. Another uniformed “solution” that will have no effect because it targets the wrong end of the problem. Why is the Mason Dixon Line now called the “Obesity Line”?

    Fix our broken food culture and fix obesity. I still don’t buy the, “they’re cheaper because they die sooner theory.

  14. Another esteemed expert gets it wrong.

    Just like smokers, the obese cost more to take care of in any given year – BUT – cost less over their life time.

    Why? Shorter lives.

    I agree we should try to fight obesity. Just don’t expect it to cost less in the long run.

    Flame suit on!

  15. It’s disappointing to only see health care interventions suggested when it comes to obesity. Pills, surgery, doctor visits, all these things can help but if you live in a bad neighborhood with no safe place to exercise, and only convenience stores and fast food within walking distance or the only affordable option in the community, it’s hard to combat weight gain from a doctor’s office.