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ATLANTA – Obesity and its comorbidities loom, threatening to become an expensive national crisis, given that its treatment costs are nearly double that of other chronic diseases, and third party payers so far have failed to invest in its prevention.
"Obese individuals are about 42% more expensive than their normal weight counterparts," accounting for 9% of all medical expenditures, Eric Finkelstein, Ph.D., said at the meeting presented by the Obesity Society and the American Society for Metabolic and Bariatric Surgery.
With close to half the population expected to have a BMI greater or equal to 40 kg/m2 by 2030, even the slightest reversal of trends can save billions, according to Dr. Finkelstein, a health policy research analyst and professor at the Duke-National University of Singapore Global Health Institute (Am. J. Prev. Med. 2012;42:563-70).
‘Bend the curve’
"By 2020, if you could bend even just the cost percentage point by 1 per year, you could have 2.6 million fewer obese adults, and $3.9 billion less in medical expenditures," said Dr. Finkelstein. "By 2030, the numbers go up to 2.9 million fewer obese adults, and $9.5 billion in savings."
The way to bend the curve is through prevention, said Dr. Finkelstein. But, just what constitutes prevention and who should pay for it are not so straightforward.
Although the Affordable Care Act expanded the Centers for Medicare and Medicaid’s coverage of obesity screening and prevention, "there is some debate as to whether the ACA will help this problem," said Dr. Finkelstein.
A trifecta of politics, prejudice, and inconsistent health insurance policies may undermine the legislation’s ability to meet the challenges posed by obesity, according to the symposium presenters.
‘Ounce of prevention, pound of cure’
"Grandma was right. An ounce of prevention equals a pound of cure," noted Dr. Richard Wild, chief medical officer of the CMS in Atlanta.
To that end, he said that under the ACA, there is "more flexibility to [cover prevention] with no cost sharing to patients." CMS obesity screening, prevention, and treatment are largely tied to the U. S. Preventive Services Task Force advisory committee, said Dr. Wild.
A significant percentage of individuals in their mid-20s with class 1 obesity (BMI between 30 and 35 kg/m2) will have BMIs of 40 kg/m2 or greater before they reach their 40s, according to Dr. Finkelstein. By the time they enter their 40s, 63% of males and 78% of women will have an obesity-related comorbidity. Many of those in the 30 to 35 BMI group are likely to continue to a significant weight gain that will make them eligible for bariatric surgery fairly soon," he said.
Early intervention is key to preventing the cost of comorbidities, Dr. Finkelstein said (Surg. Obes. Relat. Dis. 2013;9:547-53).
However, CMS limits Medicare coverage of bariatric surgery to those with a BMI greater than 35 kg/m2, who have at least one related comorbidity and have proven unsuccessful at past attempts to control their weight.
Beyond that, following the USPTF Recommendation Statement (grade B) for screening and treatment of obesity in adults, behavioral intervention is covered when a person has a BMI of 30 kg/m2. If, after 6 months, the person has demonstrated a 3-kg weight loss, continued "face-to-face" weekly visits with a primary care provider of behavioral intervention can continue up to another 6 months.
Politics over patients
Regardless of the point at which intervention is deemed appropriate, access to all available treatments is still not equal, said Dr. John Morton of Stanford (Calif.) University and president elect of ASBMS.
"Let’s make the playing field level," said Dr. Morton. "Everybody should have the same benefits. One Constitution for all of us, one health care benefit for all of us."
Access to bariatric surgery is limited by a number of factors, including the type of health exchange available in the state where a person lives, or whether their employer-backed health plan offers bariatric surgery and if so, at what cost.
"We believe that a big part of any sort of package should definitely be bariatric surgery," said Dr. Morton, citing data on the "tertiary prevention" provided by bariatric surgery. "We hear about statins and all the good they do. If you look at how much mortality they decrease in 5 years, it’s in the single digits. We’re talking about a 40% decrease in mortality in bariatric surgery." said Dr. Morton (N. Engl. J. Med. 2007; 357:753-61).
Noting that as BMI goes up, costs go up, Dr. Morton said that with bariatric surgery, there is a return on investment in a short amount of time. But politics gets in the way of allowing the cost-saving measures of weight reduction surgery to be applied, he said.
Since the presidential election of 2012, "a lot of states have held their fire about implementing these programs," said Dr. Morton. "But at the end of the day, you need to do what’s right for the patient."
Because bariatric surgery coverage is not mandated at the federal level, millions of American do not have access to obesity care, said Dr. Morton.
Role of prejudice
"The biggest problem we have had with this for 50 years is prejudice," Dr. Henry Buchwald, professor emeritus of the Owen H. and Sarah Davidson Wangensteen Chair in Experimental Surgery at the University of Minnesota, Minneapolis. "People are prejudiced against the obese."
Dr. Morton said that even though obesity is a disease recognized by the AMA, it is often described in exclusionary terms by third-party payers.
"When you look at the ACA, there’s language that says it cannot discriminate on the basis of a health condition, but if you look at some of these [insurance] plans, there is actually language that says ‘we will not cover obesity treatment.’ That’s exclusionary language, and we need to figure out why this is occurring."
However, Dr. Finkelstein suggested that part of the problem with getting coverage for weight loss surgery might be how the field frames their argument in favor of it.
"I think the obesity community has done themselves a disservice by pushing [return on investment] for bariatric procedures," said Dr. Finkelstein. "I don’t think bariatric surgery should be talked about in terms of value for money. The [health] value is there just like any other procedure, and so it should be covered."
Little incentive
Despite the fact that the costs of obesity over a lifetime are high in the aggregate, Dr. Finkelstein said that the costs are highest later in life. That, plus the current trend of employees changing jobs an average of every 3 years, means obesity is often overlooked.
"Even though the net costs from a lifetime perspective are significant, there is not a lot of incentive for any particular payer to do any obesity prevention because the costs are eventually shifted down the line," said Dr. Finkelstein. When the federal government picks up paying for the health care costs of everyone 65 years of age or older, you are unlikely to "see significant investments in prevention," he said.
In cases in which the individual has had no insurance prior to qualifying for Medicare, the costs are even higher, and the cases more complex. "About 25% of patients who have chronic disease with multiple comorbidities make up 85% of our costs," Dr. Wild said, adding that of those 25%, 5% are "superusers" who make up 50% of all CMS costs.
The CMS spends $1.5 billion a day, or $900 billion annually, on health care, according to Dr. Wild.
"When we talk about bending the cost curve and saving money, we need to focus on those patients with multiple comorbidities and chronic diseases," said Dr. Wild.
The agreement on this point brought the panel back to the question of what is the sweet spot for prevention and intervention, and who should pay for it.
Surgery not the only answer
"We’re not going to solve the obesity problem by surgery alone," Dr. Buchwald said, adding that a combination of approaches, including prevention, medical, and other approaches. "We have to look for things that will work together."
Dr. Morton agreed that more research into complimentary medical interventions for obesity was needed. "We have been hamstrung by not having a lot of options," he said.
"Diet and exercise do work, but we don’t diet or exercise as much as we used to and that’s part of the reason we’re in this situation," Dr. Finkelstein said.
The data support bariatric surgery as a viable way to cut costs, said Dr. Morton. "The data are on our side," he said. "We have a lot of patients in need, and I would call for some rational coverage decisions when it comes to health exchanges. I think the government can be our partners in this."
Dr. Finkelstein noted several disclosures including, Jenny Craig, Johnson & Johnson, and Sanofi-Aventis, among several others. Dr. Morton has worked with Covidien. Dr. Buchwald and Dr. Wild did not have any relevant disclosures
ATLANTA – Obesity and its comorbidities loom, threatening to become an expensive national crisis, given that its treatment costs are nearly double that of other chronic diseases, and third party payers so far have failed to invest in its prevention.
"Obese individuals are about 42% more expensive than their normal weight counterparts," accounting for 9% of all medical expenditures, Eric Finkelstein, Ph.D., said at the meeting presented by the Obesity Society and the American Society for Metabolic and Bariatric Surgery.
With close to half the population expected to have a BMI greater or equal to 40 kg/m2 by 2030, even the slightest reversal of trends can save billions, according to Dr. Finkelstein, a health policy research analyst and professor at the Duke-National University of Singapore Global Health Institute (Am. J. Prev. Med. 2012;42:563-70).
‘Bend the curve’
"By 2020, if you could bend even just the cost percentage point by 1 per year, you could have 2.6 million fewer obese adults, and $3.9 billion less in medical expenditures," said Dr. Finkelstein. "By 2030, the numbers go up to 2.9 million fewer obese adults, and $9.5 billion in savings."
The way to bend the curve is through prevention, said Dr. Finkelstein. But, just what constitutes prevention and who should pay for it are not so straightforward.
Although the Affordable Care Act expanded the Centers for Medicare and Medicaid’s coverage of obesity screening and prevention, "there is some debate as to whether the ACA will help this problem," said Dr. Finkelstein.
A trifecta of politics, prejudice, and inconsistent health insurance policies may undermine the legislation’s ability to meet the challenges posed by obesity, according to the symposium presenters.
‘Ounce of prevention, pound of cure’
"Grandma was right. An ounce of prevention equals a pound of cure," noted Dr. Richard Wild, chief medical officer of the CMS in Atlanta.
To that end, he said that under the ACA, there is "more flexibility to [cover prevention] with no cost sharing to patients." CMS obesity screening, prevention, and treatment are largely tied to the U. S. Preventive Services Task Force advisory committee, said Dr. Wild.
A significant percentage of individuals in their mid-20s with class 1 obesity (BMI between 30 and 35 kg/m2) will have BMIs of 40 kg/m2 or greater before they reach their 40s, according to Dr. Finkelstein. By the time they enter their 40s, 63% of males and 78% of women will have an obesity-related comorbidity. Many of those in the 30 to 35 BMI group are likely to continue to a significant weight gain that will make them eligible for bariatric surgery fairly soon," he said.
Early intervention is key to preventing the cost of comorbidities, Dr. Finkelstein said (Surg. Obes. Relat. Dis. 2013;9:547-53).
However, CMS limits Medicare coverage of bariatric surgery to those with a BMI greater than 35 kg/m2, who have at least one related comorbidity and have proven unsuccessful at past attempts to control their weight.
Beyond that, following the USPTF Recommendation Statement (grade B) for screening and treatment of obesity in adults, behavioral intervention is covered when a person has a BMI of 30 kg/m2. If, after 6 months, the person has demonstrated a 3-kg weight loss, continued "face-to-face" weekly visits with a primary care provider of behavioral intervention can continue up to another 6 months.
Politics over patients
Regardless of the point at which intervention is deemed appropriate, access to all available treatments is still not equal, said Dr. John Morton of Stanford (Calif.) University and president elect of ASBMS.
"Let’s make the playing field level," said Dr. Morton. "Everybody should have the same benefits. One Constitution for all of us, one health care benefit for all of us."
Access to bariatric surgery is limited by a number of factors, including the type of health exchange available in the state where a person lives, or whether their employer-backed health plan offers bariatric surgery and if so, at what cost.
"We believe that a big part of any sort of package should definitely be bariatric surgery," said Dr. Morton, citing data on the "tertiary prevention" provided by bariatric surgery. "We hear about statins and all the good they do. If you look at how much mortality they decrease in 5 years, it’s in the single digits. We’re talking about a 40% decrease in mortality in bariatric surgery." said Dr. Morton (N. Engl. J. Med. 2007; 357:753-61).
Noting that as BMI goes up, costs go up, Dr. Morton said that with bariatric surgery, there is a return on investment in a short amount of time. But politics gets in the way of allowing the cost-saving measures of weight reduction surgery to be applied, he said.
Since the presidential election of 2012, "a lot of states have held their fire about implementing these programs," said Dr. Morton. "But at the end of the day, you need to do what’s right for the patient."
Because bariatric surgery coverage is not mandated at the federal level, millions of American do not have access to obesity care, said Dr. Morton.
Role of prejudice
"The biggest problem we have had with this for 50 years is prejudice," Dr. Henry Buchwald, professor emeritus of the Owen H. and Sarah Davidson Wangensteen Chair in Experimental Surgery at the University of Minnesota, Minneapolis. "People are prejudiced against the obese."
Dr. Morton said that even though obesity is a disease recognized by the AMA, it is often described in exclusionary terms by third-party payers.
"When you look at the ACA, there’s language that says it cannot discriminate on the basis of a health condition, but if you look at some of these [insurance] plans, there is actually language that says ‘we will not cover obesity treatment.’ That’s exclusionary language, and we need to figure out why this is occurring."
However, Dr. Finkelstein suggested that part of the problem with getting coverage for weight loss surgery might be how the field frames their argument in favor of it.
"I think the obesity community has done themselves a disservice by pushing [return on investment] for bariatric procedures," said Dr. Finkelstein. "I don’t think bariatric surgery should be talked about in terms of value for money. The [health] value is there just like any other procedure, and so it should be covered."
Little incentive
Despite the fact that the costs of obesity over a lifetime are high in the aggregate, Dr. Finkelstein said that the costs are highest later in life. That, plus the current trend of employees changing jobs an average of every 3 years, means obesity is often overlooked.
"Even though the net costs from a lifetime perspective are significant, there is not a lot of incentive for any particular payer to do any obesity prevention because the costs are eventually shifted down the line," said Dr. Finkelstein. When the federal government picks up paying for the health care costs of everyone 65 years of age or older, you are unlikely to "see significant investments in prevention," he said.
In cases in which the individual has had no insurance prior to qualifying for Medicare, the costs are even higher, and the cases more complex. "About 25% of patients who have chronic disease with multiple comorbidities make up 85% of our costs," Dr. Wild said, adding that of those 25%, 5% are "superusers" who make up 50% of all CMS costs.
The CMS spends $1.5 billion a day, or $900 billion annually, on health care, according to Dr. Wild.
"When we talk about bending the cost curve and saving money, we need to focus on those patients with multiple comorbidities and chronic diseases," said Dr. Wild.
The agreement on this point brought the panel back to the question of what is the sweet spot for prevention and intervention, and who should pay for it.
Surgery not the only answer
"We’re not going to solve the obesity problem by surgery alone," Dr. Buchwald said, adding that a combination of approaches, including prevention, medical, and other approaches. "We have to look for things that will work together."
Dr. Morton agreed that more research into complimentary medical interventions for obesity was needed. "We have been hamstrung by not having a lot of options," he said.
"Diet and exercise do work, but we don’t diet or exercise as much as we used to and that’s part of the reason we’re in this situation," Dr. Finkelstein said.
The data support bariatric surgery as a viable way to cut costs, said Dr. Morton. "The data are on our side," he said. "We have a lot of patients in need, and I would call for some rational coverage decisions when it comes to health exchanges. I think the government can be our partners in this."
Dr. Finkelstein noted several disclosures including, Jenny Craig, Johnson & Johnson, and Sanofi-Aventis, among several others. Dr. Morton has worked with Covidien. Dr. Buchwald and Dr. Wild did not have any relevant disclosures
ATLANTA – Obesity and its comorbidities loom, threatening to become an expensive national crisis, given that its treatment costs are nearly double that of other chronic diseases, and third party payers so far have failed to invest in its prevention.
"Obese individuals are about 42% more expensive than their normal weight counterparts," accounting for 9% of all medical expenditures, Eric Finkelstein, Ph.D., said at the meeting presented by the Obesity Society and the American Society for Metabolic and Bariatric Surgery.
With close to half the population expected to have a BMI greater or equal to 40 kg/m2 by 2030, even the slightest reversal of trends can save billions, according to Dr. Finkelstein, a health policy research analyst and professor at the Duke-National University of Singapore Global Health Institute (Am. J. Prev. Med. 2012;42:563-70).
‘Bend the curve’
"By 2020, if you could bend even just the cost percentage point by 1 per year, you could have 2.6 million fewer obese adults, and $3.9 billion less in medical expenditures," said Dr. Finkelstein. "By 2030, the numbers go up to 2.9 million fewer obese adults, and $9.5 billion in savings."
The way to bend the curve is through prevention, said Dr. Finkelstein. But, just what constitutes prevention and who should pay for it are not so straightforward.
Although the Affordable Care Act expanded the Centers for Medicare and Medicaid’s coverage of obesity screening and prevention, "there is some debate as to whether the ACA will help this problem," said Dr. Finkelstein.
A trifecta of politics, prejudice, and inconsistent health insurance policies may undermine the legislation’s ability to meet the challenges posed by obesity, according to the symposium presenters.
‘Ounce of prevention, pound of cure’
"Grandma was right. An ounce of prevention equals a pound of cure," noted Dr. Richard Wild, chief medical officer of the CMS in Atlanta.
To that end, he said that under the ACA, there is "more flexibility to [cover prevention] with no cost sharing to patients." CMS obesity screening, prevention, and treatment are largely tied to the U. S. Preventive Services Task Force advisory committee, said Dr. Wild.
A significant percentage of individuals in their mid-20s with class 1 obesity (BMI between 30 and 35 kg/m2) will have BMIs of 40 kg/m2 or greater before they reach their 40s, according to Dr. Finkelstein. By the time they enter their 40s, 63% of males and 78% of women will have an obesity-related comorbidity. Many of those in the 30 to 35 BMI group are likely to continue to a significant weight gain that will make them eligible for bariatric surgery fairly soon," he said.
Early intervention is key to preventing the cost of comorbidities, Dr. Finkelstein said (Surg. Obes. Relat. Dis. 2013;9:547-53).
However, CMS limits Medicare coverage of bariatric surgery to those with a BMI greater than 35 kg/m2, who have at least one related comorbidity and have proven unsuccessful at past attempts to control their weight.
Beyond that, following the USPTF Recommendation Statement (grade B) for screening and treatment of obesity in adults, behavioral intervention is covered when a person has a BMI of 30 kg/m2. If, after 6 months, the person has demonstrated a 3-kg weight loss, continued "face-to-face" weekly visits with a primary care provider of behavioral intervention can continue up to another 6 months.
Politics over patients
Regardless of the point at which intervention is deemed appropriate, access to all available treatments is still not equal, said Dr. John Morton of Stanford (Calif.) University and president elect of ASBMS.
"Let’s make the playing field level," said Dr. Morton. "Everybody should have the same benefits. One Constitution for all of us, one health care benefit for all of us."
Access to bariatric surgery is limited by a number of factors, including the type of health exchange available in the state where a person lives, or whether their employer-backed health plan offers bariatric surgery and if so, at what cost.
"We believe that a big part of any sort of package should definitely be bariatric surgery," said Dr. Morton, citing data on the "tertiary prevention" provided by bariatric surgery. "We hear about statins and all the good they do. If you look at how much mortality they decrease in 5 years, it’s in the single digits. We’re talking about a 40% decrease in mortality in bariatric surgery." said Dr. Morton (N. Engl. J. Med. 2007; 357:753-61).
Noting that as BMI goes up, costs go up, Dr. Morton said that with bariatric surgery, there is a return on investment in a short amount of time. But politics gets in the way of allowing the cost-saving measures of weight reduction surgery to be applied, he said.
Since the presidential election of 2012, "a lot of states have held their fire about implementing these programs," said Dr. Morton. "But at the end of the day, you need to do what’s right for the patient."
Because bariatric surgery coverage is not mandated at the federal level, millions of American do not have access to obesity care, said Dr. Morton.
Role of prejudice
"The biggest problem we have had with this for 50 years is prejudice," Dr. Henry Buchwald, professor emeritus of the Owen H. and Sarah Davidson Wangensteen Chair in Experimental Surgery at the University of Minnesota, Minneapolis. "People are prejudiced against the obese."
Dr. Morton said that even though obesity is a disease recognized by the AMA, it is often described in exclusionary terms by third-party payers.
"When you look at the ACA, there’s language that says it cannot discriminate on the basis of a health condition, but if you look at some of these [insurance] plans, there is actually language that says ‘we will not cover obesity treatment.’ That’s exclusionary language, and we need to figure out why this is occurring."
However, Dr. Finkelstein suggested that part of the problem with getting coverage for weight loss surgery might be how the field frames their argument in favor of it.
"I think the obesity community has done themselves a disservice by pushing [return on investment] for bariatric procedures," said Dr. Finkelstein. "I don’t think bariatric surgery should be talked about in terms of value for money. The [health] value is there just like any other procedure, and so it should be covered."
Little incentive
Despite the fact that the costs of obesity over a lifetime are high in the aggregate, Dr. Finkelstein said that the costs are highest later in life. That, plus the current trend of employees changing jobs an average of every 3 years, means obesity is often overlooked.
"Even though the net costs from a lifetime perspective are significant, there is not a lot of incentive for any particular payer to do any obesity prevention because the costs are eventually shifted down the line," said Dr. Finkelstein. When the federal government picks up paying for the health care costs of everyone 65 years of age or older, you are unlikely to "see significant investments in prevention," he said.
In cases in which the individual has had no insurance prior to qualifying for Medicare, the costs are even higher, and the cases more complex. "About 25% of patients who have chronic disease with multiple comorbidities make up 85% of our costs," Dr. Wild said, adding that of those 25%, 5% are "superusers" who make up 50% of all CMS costs.
The CMS spends $1.5 billion a day, or $900 billion annually, on health care, according to Dr. Wild.
"When we talk about bending the cost curve and saving money, we need to focus on those patients with multiple comorbidities and chronic diseases," said Dr. Wild.
The agreement on this point brought the panel back to the question of what is the sweet spot for prevention and intervention, and who should pay for it.
Surgery not the only answer
"We’re not going to solve the obesity problem by surgery alone," Dr. Buchwald said, adding that a combination of approaches, including prevention, medical, and other approaches. "We have to look for things that will work together."
Dr. Morton agreed that more research into complimentary medical interventions for obesity was needed. "We have been hamstrung by not having a lot of options," he said.
"Diet and exercise do work, but we don’t diet or exercise as much as we used to and that’s part of the reason we’re in this situation," Dr. Finkelstein said.
The data support bariatric surgery as a viable way to cut costs, said Dr. Morton. "The data are on our side," he said. "We have a lot of patients in need, and I would call for some rational coverage decisions when it comes to health exchanges. I think the government can be our partners in this."
Dr. Finkelstein noted several disclosures including, Jenny Craig, Johnson & Johnson, and Sanofi-Aventis, among several others. Dr. Morton has worked with Covidien. Dr. Buchwald and Dr. Wild did not have any relevant disclosures
EXPERT ANALYSIS FROM OBESITY WEEK
