Keep Out

Obesity Treatment Prevention Is Working Very Well

Obesity treatment prevention is probably the one and only obesity-related policy that is working with 99% effectiveness. A new study in Obesity gives us hard numbers for this overwhelming success.

John Batsis and Julie Bynum analyzed Medicare claims from 2012 and 2013 for more than 27 million beneficiaries. They were looking for people who received intensive behavioral therapy for obesity that Medicare began covering in 2011. Only 0.60% of people with obesity received it in 2013. That’s up from 2012 when only 0.35% received it. Batsis and Bynum comment that:

The lack of uptake may be due to a lack of provider knowledge, need for more time for diffusion into practice, or the way in which the MOB (Medicare obesity benefit) is structured.

In fact, this finding is just one artifact of a broad, unwritten policy of obesity treatment prevention. Medicare has implemented its coverage for intensive behavioral therapy of obesity in a way that almost guarantees it won’t be used. Only primary care providers are allowed to deliver it. But research is clear that PCPs rarely bring up the subject of obesity. When they do, they “instruct the patient to lose weight” and leave it at that.

No one should be surprised that very few PCPs are delivering intensive behavioral care for obesity.

Policymakers for Medicare and most other health plans seem scared to death that 90 million people with obesity are about to come storming through the gates asking for obesity treatment. So they have constructed a fortress of obesity treatment prevention.

Those policies make it virtually impossible for healthcare professionals who are skilled in treating obesity – dietitians, clinical psychologists, obesity medicine physicians – to receive payment from Medicare or any other health plan for intensive behavioral therapy. They exclude pharmacotherapy for obesity from most health plans. They make coverage for bariatric surgery so difficult and limited that many patients give up on it.

The Treat and Reduce Obesity Act aims correct some of these problems in Medicare, but progress is slow.

Obesity treatment prevention ignores the reality of how obesity is crushing our healthcare system. While this policy very effectively discourages most people from seeking care for obesity, people are flooding the system with diseases that result from untreated obesity.

We are spending more than a trillion dollars on type 2 diabetes, cardiovascular disease, cancer care, liver disease, and a long list of other diseases that result from untreated obesity. We are making good efforts to prevent obesity in the community, but the prevalence continues to grow.

Nothing much is working, except for systematic policies that prevent people who want help to overcome obesity from getting that help. Those policies are working very, very well.

Click here for the study by Batsis and Bynum.

Keep Out, photograph © Jay Park Photography / flickr

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August 5, 2016

5 Responses to “Obesity Treatment Prevention Is Working Very Well”

  1. August 05, 2016 at 10:13 am, Allen Browne said:


    Great post. I thought you were talking about prevention and you were – prevention of treatment of obesity. But it took me awhile to tune in. Very logical and factual and effective with me. Now – how to get data and reason to overcome dogma and bias.


    • August 05, 2016 at 11:54 am, Ted said:

      Thanks, Allen!

  2. August 05, 2016 at 12:18 pm, Stephen Phillips said:

    The Medicare Obesity Benefit (MOB)
    • One face-to-face visit every week for the first month; • One face-to-face visit every other week for months 2-6; and • One face-to-face visit every month for months 7-12
    If the patient does not meets the 6.6lb weight-loss requirement during the first 6 months, treatments typically end. After an additional 6 months patients that did not lose a minimum of 6.6lb can be reassessed for additional obesity treatment. Physicians are required to maintain weight loss records.

    Before a claim is made that “Obesity Treatment Prevention Is Working Very Well” what we need John Batsis and Julie Bynum to tell us is how effective the treatments have been and not how many patients have been treated
    Demonstrating the effectiveness of MOB could encourage Medicare policy makers and other insurance underwriters to expand obesity services

    Stephen Phillips
    American Association of Bariatric Counselors

    • August 05, 2016 at 1:08 pm, Ted said:

      Stephen, the point here is that Medicare (and other health plans) are doing a very good job of preventing people from receiving care for obesity, such as intensive behavioral therapy.

      The fact that only 0.6% of people with obesity have had even only one episode of care is pretty compelling to me.

  3. August 05, 2016 at 2:52 pm, Stephen Phillips said:

    We are on the same page
    iMy perspectve is that prudent policy makers would want to see outcome studies that demonstrate the efficacy of weight-loss and related risk reductions…this would encourage expanded coverage that could include pharmaceuticals and multi-disciplinary health providers. Outcome studiest benefits both the insurers and the public .That could prevent treatment prevention….so to speak