Obesity rates among older Americans are sharply rising. By 2030, nearly half of Medicare beneficiaries will have obesity, up from 28% in 2010. Even more concerning, the number of people over the age of 65 with severe obesity (BMI over 40) is expected to double in the twenty-year period from 2010 to 2030.
The increasing prevalence of obesity correlates with increasing healthcare costs. Obesity exacerbates the risk of developing other conditions like diabetes, heart disease, and cancer — conditions that cost the US healthcare system over 500 billion dollars a year.
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It’s puzzling, then, that Medicare is restricted from treating obesity as a disease to prevent all of those costly downstream effects. After all, the American Medical Association classified obesity as a disease in 2013, but the government continues to lag behind in its coverage for treatment.
While some Medicare plans do cover in-person Intensive Behavioral Therapy for obesity, most don’t cover a host of other evidence-based interventions like virtual weight loss programs, nutritional counseling, anti-obesity medications, or bariatric surgery.
To be sure, many of these interventions are time-intensive and expensive. There’s no way around it; treating obesity requires a dedicated partnership between providers and patients. It often takes an investment of time, money, and effort before results appear. Even bariatric surgery isn’t a quick fix. But since Medicare is typically a multi-year insurer, the government has time to capture the savings from anti-obesity treatment interventions.
Medicare is failing its beneficiaries by not treating obesity as a disease. Just like people with high blood pressure often need to take medications to avoid disease-related complications, people with obesity need access to all appropriate, evidence-based therapies to combat the disease.
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It’s past time for Medicare to fully address one of the biggest health crises of our time and recognize obesity as the dangerous disease it is. Medicare can draw upon a variety of obesity treatments that have come to the market in recent years.
One of the most cost-effective first-tiered approaches to obesity treatment includes app-based behavioral counseling programs. Thankfully, Medicare is already catching on to this approach and partnering with virtual cardiometabolic care companies that provide diabetes prevention programs (DPP). These companies offer access to well-credentialed care teams of physicians, registered dietitians, health coaches, and therapists, along with sophisticated machine learning tools, to help people adopt healthier habits. Some even prescribe new weight loss medications as a step up in treatment for those individuals who really need them.
Recently approved by the Food and Drug Administration, these new weight loss medications show a lot of promise. They provide a second tier of treatment for those who can’t get the results they need through behavior change alone. Glucagon-like peptide-1 receptor agonists (GLP-1s) can help people lose 15% to 20% of their body weight — significantly more weight loss compared to previous drug therapies. These can also be especially helpful for older adults who struggle with mobility issues and other barriers that can make weight loss enormously challenging.
When behavioral therapy and medications fail to work well enough, new guidelines recommend surgical interventions to treat obesity as a third-tier option. The American Society for Metabolic and Bariatric Surgery now suggests surgery for people with a BMI of 35 or higher, regardless of any other obesity-related conditions present.
There’s no doubt that surgery and newer anti-obesity medications are costly. However, we must consider the cost of withholding evidence-based treatments for obesity. Obesity is already linked to billions of dollars of Medicare expenditures.
By treating obesity appropriately, with evidence-based interventions, Medicare stands to save total costs of care in the long run. Under-treating obesity leads to downstream conditions like diabetes, hypertension, hyperlipidemia, heart disease, and cancer. And it comes at the cost of rising health inequity in our country.
Black Americans and Hispanic Americans have some of the highest rates of obesity at 50% and 45% respectively, according to a CDC survey. Those disadvantaged groups also have higher rates of diabetes and worse outcomes. Black adults are 60% more likely than white adults to have diabetes and twice as likely to die from it.
For as expensive as anti-obesity treatments may be, Medicare can’t afford not to invest in evidence-based weight loss therapies for its beneficiaries. Our nation’s most vulnerable elderly citizens deserve quality care backed by science.
Photo: Antonio_Diaz, Getty Images
Richard Frank, MD, MHSA, Chief Medical Officer, Vida Health is an experienced physician executive with demonstrated success in product development and strategy, managing high-risk Medicare and Medicaid populations, developing new business for established and VC-backed companies, engaging providers in value-based contracts, controlling healthcare utilization, and implementing clinical programs within not-for-profit and publicly traded companies.
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