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.