Observations on Obesity and New Medicare Policy to Cover It

We are digging our graves with our own teeth.

Thomas Moffett (1820-1908), Irish Poet and Educator

December 2, 2011 – Medicare has announced it will cover obesity screening and counseling as a free preventive service.

Under the new rules, physicians will be paid to screen and counsel beneficiaries with a Body Mass Index (BMI) of 30 or more. The counseling can take place once a week for a month, then every month for 5 more months. Patients who lose 6.6 pounds or more at the end of 6 months will be eligible for 6 more counseling sessions. This is Medicare's 6-6-6-6 plan.

As things now stand, 30% of Medicare patients have BMIs of 30 or more. Many private plans cover bariatric surgery for the morbidly obese (BMIs of 40 or more), which is found in 2% of men and 4% of women, but they do not pay for screening or counseling.

Will the new CMS policy bring down obesity rates and slim waistlines?

The answer is unknowable at this point. But politically, it may not matter. Government success is measured in good intentions, not results. It is a good thing to pay doctors to advise on obesity, which leads to diabetes, heart disease, hypertension, sleep apnea, and high health costs. And it is a good thing always to offer “free” preventive services.

Who knows? An ounce of preventive counseling may be worth a pound of flesh and ward off a future disease. Given the scale of the obesity epidemic, it’s worth a government try.

I suspect, however, CMS has bitten off more than it can chew. Its good intentions remind me of the maxim: seek simplicity but distrust it.

Everybody knows these simple obesity rules.

• Eat less, move more, weigh less.

• More calories in, less calories out, more weight on.

• Choose veggies, eschew salt,carbs, sweets, red meat, and fats.

• Obey the law of small portions.

Besides, everybody knows inside every fat person there is a thin person wildly waving to get out. And , of course, everybody knows obesity is a mental state brought on by bad habits, boredom, low self-esteem, and disappointment.

But what few say, not often enough, is that obesity is a complex multidimensional cultural problem brought on by:

• Ubiquitous marketing of fast foods and sugary drinks.

• Poverty and distance from stores selling convenient fresh foods.

• Sedentary life styles accompanying video games, TV, on-line computer sitting.

• 2-3 automobiles per American family.

• Lack of sidewalks and walking paths.

• No more recess and time for outdoor games.

• Habits of the human heart which celebrate and congregate around tables of food.

• Sheer pleasures of tastey foods, beautifully served, and accompanied by animal spirits.

As H.L. Mencken (1880-1956) sagely observed, “For every complex problem there is an answer that is clear, simple, and wrong,” which may be why the Center of Disease Control reports that 98% of all attempts to lose weight fail.

Still, as the French say C’est quoi l’expression,, loosely translated as "It is worth a try."

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