Rob Stein and Ceci Connolly, Washington Post
WASHINGTON, D.C. -- The federal Medicare program on Thursday abandoned a long-standing policy that obesity is not a disease, removing what has been a major roadblock for many people trying to get treatment for the burgeoning health problem.
After years of review, the Centers for Medicare & Medicaid Services, which runs the health program for the elderly and disabled, announced it was dropping language that had led the agency to routinely deny coverage for a host of weight-loss therapies.
While the decision does not automatically mean any specific treatment will be covered, the move opens the door to what is expected to be a flood of applications from individuals, doctors and companies for Medicare to begin paying for a wide variety of therapies. These include stomach surgery, diet programs, and behavioral and psychological counseling.
"Obesity is a critical public health problem in our country that causes millions of Americans to suffer unnecessary health problems and die prematurely," Health and Human Services Secretary Tommy Thompson said in announcing the long-awaited decision. "With this new policy, Medicare will be able to review scientific evidence in order to determine which interventions improve health outcomes for seniors and disabled Americans who are obese."
This latest in a series of steps the federal government has taken to fight the nation's rising obesity problem was hailed by public health experts, anti-obesity advocates and doctors.
"Conceptually this is a huge change, for the medical profession, for insurers, and for employers, to treat this just like any other disease," said Morgan Downey, executive director of the American Obesity Association, an advocacy group that has been lobbying for the change. Because private insurance companies often pattern their coverage after Medicare, the decision is expected to put strong pressure on them to expand coverage for weight-loss treatments. Representatives from the insurance industry, which recently has begun scaling back payments for stomach surgery, welcomed the decision and signaled companies would take their cues from Medicare.
"We're going to be watching this very closely," said Karen Ignagni, president of America's Health Insurance Plans, the industry's primary trade group. "We're going to be looking at what they are evaluating and what their results are."
Private health plans in Minnesota already cover obesity treatments, including stomach surgeries that can cost $25,000 and require extensive care before and after the procedure.
However, patients have to meet certain criteria to be eligible for the surgery, health plan officials said. Usually, that means they must have a body mass index of at least 35 and other conditions such as diabetes, heart disease and high blood pressure. They must also have tried and failed to lose weight on their own.
"For some people it's appropriate. For others it is not," said Eileen Smith, spokesperson for the Minneapolis Council of Health Plans.
She said providing obesity coverage is routine for private insurers, and has been for several years. While some smaller employers who are self-insured might not pay for such treatment, for most "it's part of the package," she said.
In addition to the practical implications of getting insurance to pay for more treatment, many experts said the move would help counter the stigma that often plagues people who are overweight and obese.
"The lack of recognition of obesity as disease has cast a pall over the field. Now Medicare is saying obesity deserves treatment like any other disease," said Louis Aronne, president elect of the North American Association for the Study of Obesity.
Move called irrational
The decision was, however, denounced by critics who say the health consequences of being overweight have been exaggerated and any real problem is one of individual responsibility.
"This is truly a dumbing down of the term 'disease'. This is the only disease that I'm familiar with that you can solve by regularly taking long walks and keeping your mouth shut," said Rick Berman, executive director of the Center for Consumer Freedom, a food-industry funded advocacy group. "It's terrible to start using taxpayer money like this when there are other legitimate diseases that need to be addressed."
The decision is irrational, given that being underweight is more of a health problem for the elderly than being overweight, said Paul Campos of the University of Colorado, author of the recent book "The Obesity Myth."
"It's not just a bad idea, it's completely unscientific," he said. "We're in the grip of a kind of out-of-control cultural hysteria on this issue that leads to really irrational social decisions, such as making obesity a disease among the elderly."
Because it was unclear exactly what Medicare would eventually pay for, there were no immediate estimates of what the policy change would cost the government.
The decision will not affect weight-loss drugs, but Downey said his group planned to press Congress to address that issue the next time it reconsiders Medicare's new prescription drug benefit.
Staff writer Josephine Marcotty contributed to this report.