Obesity Counseling: Wasteful?

Last week, the Centers for Medicare and Medicaid Services (CMS) — the federal agency that runs Medicare — announced that Medicare will begin to cover behavioral therapy and dietary counseling for people who are obese (defined by a body-mass index of 30 or higher). This announcement comes as no surprise, as CMS proposed covering such treatments in September and offered a 90-day comment period. Nevertheless, some of the details of how Medicare will cover treatments are attracting fresh criticism.

According to an article at MedPage Today, obese Medicare enrollees will now be able to receive weekly behavioral-therapy counseling in a primary-care setting for one month, followed by further sessions every two weeks for the next five months. If the person loses at least 3 kilograms (6.6 pounds) during these six months, Medicare will cover monthly sessions for another six months. All of these counseling sessions will be covered completely by Medicare, with no co-pays.


Peter Jacobson, a health policy professor interviewed for the MedPage Today article, took issue with Medicare’s coverage only of counseling that takes place in a primary-care setting, calling this “necessary but not sufficient to address the obesity epidemic.” Covering specialty practices and counseling centers, he noted, could lead to more effective treatments. Robert Eckel, MD, a former president of the American Heart Association, doubted that the treatments offered by Medicare would lead to sustained weight loss after the first year and worried that they would simply cost the program money without resulting in better health. And health policy professor Robert Field noted that people who are obese at an advanced age — those covered by Medicare — would most likely need to break lifelong habits to achieve significant weight loss, a tall order.

The decision to cover obesity-related counseling under Medicare comes on the heels of two discouraging research announcements. One is that according to the most recent Gallup-Healthways Well-Being Index — based on surveys conducted in the US, Britain, and Germany — a quarter of Americans are obese. As noted in an article from UPI, the survey found that 25% of Americans were obese, compared with 20% of Britons and just over 10% of Germans. Furthermore, obese survey respondents were more than twice as likely to have high blood pressure, to have high cholesterol, or to have had a heart attack — and six times as likely to have diabetes — as those who were not obese.

Separately, last month a Bloomberg article described how a growing number of scientists believe that processed and sugary foods and drinks have addictive properties that mirror those of drugs such as cocaine and nicotine, based on studies that have compared brain scans of obese people and compulsive eaters with those of drug addicts. As the article notes, companies that sell processed foods are quick to point out their healthier offerings — but, in a typical example, PepsiCo uses roughly 80% of its marketing budget to promote snack foods and soft drinks. Naturally, the industry disputes the idea that its products are addictive and rejects calls to label or regulate its products as such.

What do you think — is Medicare’s new coverage of obesity-related counseling the right move, or likely not to make such of a difference? Should private health insurance companies be required to offer obesity-related counseling as well? Given the severity of the US obesity epidemic, are more drastic measures called for — such as labeling certain junk foods as dangerous, restricting their advertising, or imposing a special tax on them? Leave a comment below!

  • PAT

    I think they should help those who want to help themselves and want to proactive in their care. Work on the preventive before any disease raise its ugly head. Treating a disease is more costly and trying to prevent it. But treating a disease is just as important too for those who need it. It is not wasteful to help folk. We are our brothers keeper!

  • Suzanne

    This isn’t being covered by regular insurance policies, so by the time someone qualifies for Medicare, it is way too late. It is a waste of taxpayer dollars. It’s like telling a smoker in the final stages of lung cancer to enter a smoking cessation program or an alcoholic with liver failure to go to AA. Why bother?

  • Becky

    How cruel and heartless you are Suzanne. Why bother! Why don’t we just withhold medical treatment because a person is too old to bother with.

  • jim snell

    Its never too late to undertake correctivs steps on ones diabetes.

    As one who was heading down the rotting path to the graveyard and finally got liver excess release stopped and through diet and hearty exercise arrested the crud/crap; it is important to solve issues and then thru carb control and heraty exercise keep body running properly. I am 64.

    My beef is with all the bum, ancient horse and buggy whip misleading information out there seving no one.

    The ADA needs to start reading all their own reserach papers as they actually contain gems of research data and clues contrary to all the other crap published.

    WHile chasing fat and obesity is a interesting approach. Scienticic research on cell physiology clearly shows that as fat and skeletal muscle cells get filled up to the top with glucose in their local stores; these cells shut dowm their response to the internal generated pancreatic insulin.

    Adding more insulin is a war against the body attempting to force in more glucose the cells do not want. Avandia/actos are sometimes added to force more glucose in.

    That is not an argument against adding extra insulin as the type 2 pancrease in many cases needs a boost on top of the body release due to wear and tear and aging. Just simply solve the insulin resistance first dammit.

    For type two diabetics, energy balance of the foor eaten and resulting glucose burned off is far more critical and the fairy tales told about just add more insulin – a type one mentality will condem a type 2 to a grim ending of rot.

    Eat food and add insulin is a one half incomplete study. The other one half is that one needs to do hearty exercise to burn the glucose off. Insulin does not do that.

    In the end I pray that the industry peddling unscientific , vague and misleading cures get their head out of the wrong dead end tunnels with the lights turned off and carefully review all the papers they have sponsored on metformin research and use, cell physiology and insulin resistance.

    The current pack of lies led me astry in the 80’s adn have had to make up for lost time and learn to balance the energy equation in my body as I am not moving 2 ton stone blocks by hand for the pharohs tombs and eddifices. If I was, I could attend Roman orges each and every day.

    In the day of 24/7 readily availaiable high energy snacks, foods. sugars coupled with energy saving low effort high tech lap top computers, video games, cars etc. is causing maximum mayhem on the Hunter Gatherer gene digestion system optimized for scare, unreliable , low quality food sources that tend to go unavailable in those days. The issue of energy management in this body type was not needed, nature didn’t bother in the past and is critical today to prevent type 2 diabetes and attendent body rot.

    It is criminal in my mind that Liver leakage, carb control and sufficient hearty exercise necessary to balance the energy equation is totally missed, ignored and played down.

    I am disgusted by all this nonsense in these grand days of science and tools. Or are these days ending due to all the economic malaise and collapse arround us.

  • Sue

    Oh, wow! Yes, definitely do obesity counceling and cut off Lantus to those who need it all at the same time. Cutting the Lantus from those who need it will cause the Medicare recipient to go out of compliance with their diabetes regimen and they will definitely lose weight at the same time they are being yelled at for being obese from taking too much insulin and being yelled at for being out of compliance!!

    To he** with the whole mess! I should be signing up for Medicare this spring, but the more I read the less I want to have to do with this entire subject.