With a stroke of the pen on July 15, obesity became a disease.
It already had been declared by one government agency as the second leading cause of death in America, right behind tobacco. And the government had already pegged the prevalence of overweight and obesity at about two-thirds of the U.S. population, costing at least $75 billion in federal money to treat.
So, with the epidemic of obesity having already reached a tipping point, so to speak, and with an election coming up, it took no great courage for the Department of Health and Human Services to remove the rule that obesity is not a disease. Until now, Medicare would not pay for treating obesity except insofar as it was associated with another disease or if the patient was morbidly obese.
The interesting part, and the hopeful part from an administration that has been pilloried for its cavalier attitude toward science in other areas, is that future coverage will depend on evidence that a particular intervention or therapy actually works.
No immediate changes are expected in the Medicare program, but henceforth, individuals are free to petition Medicare to declare obesity interventions medically necessary, and the decision will be made based on the evidence of effectiveness.
The head of the Medicare program, Mark McClellan, is both an M.D., and an economist - professions right behind law in their reliance on evidence. McClellan said, �The question isn�t whether obesity is a disease or a risk factor. What matters is whether there�s scientific evidence that an obesity-related medical treatment improves health.�
The increasing, but as yet underappreciated, need for medicine to rely on actual evidence rather than anecdotes and tradition goes hand in hand with the need to look at disease as something the victim is not always responsible for.
In another forum, McClellan acknowledged to a gathering of health advocates that the buzzword �personal responsibility� can be �a euphemism for abandoning people,� but it also is a necessity for people to take charge of their own health care as technology permits health care to become tailored to an individual�s specific genetic makeup and medical history.
McClellan heads an agency that by law is concerned with financing health care, not improving it. So it is, indeed, refreshing to have an M.D. in that position, saying, �As a doctor, I view Medicare as a public health program� and that �we mean it � that we are moving from treating the complexities of disease to preventing disease.�
�Better evidence is at the center of better medical decision-making,� says McClellan, who promises to start looking at outcomes research in deciding which services Medicare and Medicaid will cover.
If only those notions were shared by the policy makers who, contrary to the evidence, decided that abstinence-only sex education really works and that the morning-after pill really doesn�t.