Health Plans Often Stand in the Way of Obesity Care

New research from two separate studies presented at ObesityWeek in New Orleans demonstrates that health plans often stand in the way of obesity care. In one study, researchers from Harvard, ConscienHealth, and the Obesity Action Coalition found that most Americans report they don’t have health insurance that will pay for obesity care recommended in evidence-based guidelines. These include dietary counseling, medical obesity treatment, and bariatric surgery.

Even for people with employers that are targeting obesity in their wellness programs, more often than not, people do not believe that their health insurance will even cover dietary counseling by a registered dietitian. Reported coverage for medical obesity treatment (43%), obesity medicines (37%), and bariatric surgery is even lower. Ted Kyle presented the results on Thursday.

Ruchi Doshi presented research from the Bloomberg School of Public Health at Johns Hopkins. She reported that most health professionals (57%) believe that better insurance coverage for weight management services is important for providing better obesity care in clinical practice. Scott Kahan, director of the National Center for Weight and Wellness in Washington, DC, and a spokesman for the Obesity Society commented:

While self-management strategies, such as following a commercial diet or increasing exercise, can help in some individuals, most people with obesity, especially those with severe obesity, can benefit from a comprehensive approach that includes healthcare professional support.

Joe Nadglowski, President and CEO of the Obesity Action Coalition, added:

Our members report heartbreaking struggles to obtain insurance coverage for services like bariatric surgeries and obesity medicines that are necessary to reduce and prevent the obesity from ravaging their health. Sometimes they are outright denied coverage. Sometimes they are presented with absurd hurdles that have the same effect.

Harvard Obesity Medicine Physician Fatima Cody Stanford participated in the coverage gap research and commented on its implications:

Without coverage, many people must go without good medical care for obesity. The irony is that untreated obesity leads to a host of chronic diseases – like diabetes and heart disease – that wind up costing health plans even more. The current situation makes little sense, financially or medically.

Click here for the abstract of the study presented by Kyle and here for the study by Doshi et al. Click here for Kyle’s slides.

To view the original source of this blog, please click here.

October 5, 2016 Comments are off OCAN

AACE Announces the Launch of the Obesity Resource Center

The AACE Obesity Resource Center is a compendium of educational tools to educate AACE members and other health care professionals about the rapidly evolving landscape of obesity science and pharmacotherapy and complications-centric strategies that will result in improved long-term maintenance of weight loss in patients with obesity. The content is divided into three sections, each containing detailed, downloadable slide decks:

  • What is the disease of obesity?
  • Why do we treat obesity?
  • How do we treat obesity?

The Obesity Resource Center joins the successful, highly accessed Diabetes Resource Center, originally launched in 2013. This site is continually updated with new therapy information, downloadable slide decks, and current news items.

New Research Shows Keeping the Weight off is a Lot More than Willpower

Both moderate and dramatic weight loss lower metabolic rate; Less weight loss is still beneficial to health

In a special mini-series in the journal, leading obesity experts weigh in on the two papers through two additional commentaries and an editorial, all of which explain the phenomenon of metabolic adaptation, or the process where weight loss is accompanied by a decline in energy (caloric) expenditure as weight is lost. These studies were conducted on different populations, but reached the same conclusion: weight regain results from complex biological forces. The common accusation that individuals who don’t keep the weight off just lack willpower is incorrect.

“Obesity is a serious disease that cannot be ‘cured’ with weight loss,” says Donna Ryan, MD, FTOS, Associate Editor in Chief of Obesity and spokesperson for The Obesity Society. “Research is showing that once people lose weight and their metabolism slows, they experience an increase in appetite and a decrease in energy expenditure. These studies demonstrate that keeping the weight off long term requires constant vigilance and lifestyle changes to combat the biologic factors that are fighting to regain the weight.”

In the second paper released today, researchers Michael Rosenbaum, MD, and Rudolph L. Leibel, MD, examined 17 individuals with obesity first at their usual weight, again during maintenance of a 10% reduced weight, and a final time during maintenance of a 20% reduced weight. Their goal was to determine whether the reduction in energy expenditure was directly proportional to the amount of weight lost, if it was proportional up to a certain point, or if it was increasingly – or even exponentially – proportional. They found that all three models were effective.

While these authors found that energy expenditure is explained by a combination of the three models, Fothergill et al’s research on The Biggest Loser contestants seems to fall in line with the proportional model, where the more weight is lost the more the energy expenditure will decrease.

“This study reinforces the complexities of obesity, illustrating that dramatic weight loss, such as that experienced by contestants from The Biggest Loser, may not be the best approach for keeping weight off long term,” continued Dr. Ryan. “Efforts to maintain weight loss should focus on establishing sustainable diet and physical activity routines. While they may not lead to the dramatic weight loss experienced by contestant on The Biggest Loser, they can improve overall health and well-being.”

A position statement on the topic issued today by The Obesity Society and supported by the Academy of Nutrition and Dietetics, the Obesity Action Coalition and the Obesity Medicine Association reinforces the message:

“Many people are successful at losing weight and sustaining that loss at levels that may be associated with significant health benefits, even if they do not conform to a societal cosmetic ideal… Numerous studies have demonstrated that people with obesity can lose 5 – 10% of their initial weight and many of them successfully maintain this new, lower body weight. In addition, reductions of this size are associated with improvements in hypertension, sleep apnea, mood, physical mobility and the development of Type 2 Diabetes.”

Study author Dr. Rosenbaum notes that only approximately 15% of individuals are able to lose more than 10% of their weight non-surgically and sustain the weight loss. The position statement reinforces this idea that “approximately 70% of individuals are capable of weight-reduction of at least 5%, and more than half of these individuals are able to sustain weight loss of >5% at the 8-year mark.”

“These two studies show that keeping weight off can be extremely difficult and gets even harder as more weight is lost. It’s  important to remember that moderate weight loss can be beneficial for health and likely won’t come with such a forceful fight by the body to regain the weight,” says The Obesity Society President Penny Gordon-Larsen, PhD, FTOS who led the development of the position statement.A front-page article in The New York Times in May spotlighted a National Institutes of Health study in Obesity that studied 14 former contestants of the reality TV show The Biggest Loser who regained an average of 90 pounds – nearly 70% of what they had lost – six years after the show because of complex factors that affected their metabolism and caused their bodies to regain the weight. Researchers explained that a lowered resting metabolic rate (RMR) was partly to blame. RMR is the rate at which calories are burned at rest, which contributes to total daily energy expenditure (TDEE). This study, which was discussed widely on the Internet following The New York Times story, is now published in the August print edition of Obesity, the scientific journal of The Obesity Society, along with a second, new paper also examining metabolic rates after weight loss.

Obesity Score 3-2 for the Affordable Care Act

Speaking at the 13th Annual Bariatric Summit in Nashville yesterday, Ted Kyle tallied a score of three pluses and two minuses for people living with obesity under the Affordable Care Act (ACA), also known as Obamacare.

uninsured-rateOn the plus side of the ledger, Kyle identified three key gains:

  • More People Have Insurance.
    For the first time in recent history, more than 90% of Americans had health insurance in 2015. The uninsured rate is down by more than four points since the ACA took effect. Previously, many people with obesity were unable to obtain health insurance because of preexisting health conditions. Now, that’s illegal.
  • Better Access to Intensive Behavioral Care.Intensive behavioral care for obesity is well-accepted as an effective preventive health service. Under the ACA, preventive services are mandated for free coverage. Health plans of all kinds are scrambling to deliver various forms of the Diabetes Prevention Program.
  • A Ban on Discriminatory Health Plans. Health plans are barred from designing their benefits in a way that discriminates against people based on any health-related condition. So in theory, plans that keep people with obesity from getting good medical care are operating outside of the law.

Two glaring negatives offset the gains:

  • Essential Health Benefits. The definition of health benefits that every plan must offer under the law is set state by state. More often than not, obesity care is not on the list of mandated benefits. Only 23 states mandate coverage for some weight management services. Usually, that service is bariatric surgery.
  • Persistent Discrimination. Even though discriminatory health plan designs are illegal, discriminatory practices aren’t hard to find. Advocacy groups have begun the tedious work of challenging the bad actors.

The bottom line is that the ACA has brought some significant progress in access to care, but it’s been incremental. Access to evidence-based obesity care has long been extremely limited. Movement is in the right direction, but routine access to obesity care requires much more work.

Click here for Kyle’s presentation and here for more from Morgan Downey and Chris Still regarding the ACA’s impact For people with obesity.

Score 3, photograph © photophilde / flickr

This blog post originally appeared on ConscienHealth. To visit the ConscienHealth Web site, please click here.

Doctors Prescribe Diabetes Treatment Medications 15 Times More than Obesity Drugs, study finds

Clinicians are missing critical opportunity to prevent diabetes with obesity treatments

screen-shot-2016-08-25-at-3-35-54-pm-1Obesity is a well-established major risk factor for developing diabetes, with almost 90% of people living with type 2 diabetes having obesity or overweight1. Even with the close tie between obesity and type 2 diabetes, new research shows that healthcare clinicians prescribe 15 times more antidiabetes medications than those for obesity. Although six antiobesity medications are now approved by the Food and Drug Administration (FDA) for treating obesity when combined with a reduced-calorie diet and increased physical activity, this research points out that only 2% of the eligible 46% of the U.S. adult population is receiving these medications. The research is published in the September issue of Obesity, the scientific journal of The Obesity Society.

“Given the close tie between obesity and type 2 diabetes, treating obesity should be an obvious first step for healthcare providers to prevent and treat diabetes,” says Catherine E. Thomas, MS, the lead researcher from Weill Medical College of Cornell University. “By treating obesity, we may be able to decrease the number of patients with type 2 diabetes, among other related diseases and the medications used to treat them.”

Researchers pointed to a number of barriers to obesity treatment including lack of reimbursement for healthcare providers, limited time during office visits, lack of training in counseling, and competing demands, among others.

“A greater urgency in the treatment of obesity – on the part of clinicians and patients – is essential,” continued Thomas. “We’re talking about prolonged and better quality of life for patients.”

To conduct the study, Thomas et al. performed a retrospective analysis of 2012 – 2015 data from the IMS Health National Prescription Audit and Xponent databases to examine prescribing trends for antidiabetes and antiobesity medications. According to the analysis, the number of prescribed antidiabetes medications (excluding insulin) was 15 times the number of prescribed antiobesity medications. Medical specialties prescribing the majority of the antiobesity medications included family medicine/general practitioners, internal medicine clinicians and endocrinologists.

“By comparing the adoption rate of new antiobesity medications to the considerably faster rate for new diabetes medications, this new research provides an important snapshot of the problem,” says Ted Kyle, RPh, MBA, founder of ConscienHealth in a commentary accompanying the research.

“Obesity is a serious disease that is not getting serious treatment,” says Charles Billington, MD, FTOS, past president and spokesperson for The Obesity Society and Director of Medical Weight Management at the University of Minnesota. “We are missing the opportunity among patients with serious obesity-related illness to provide the full range of proven, safe and effective therapies. It’s time to start treating people with obesity as we would others with chronic diseases – with compassion and access to evidence-based care in a clinical setting.”

According to the commentary by Kyle, future research should aim to better quantify the benefit of obesity medications in real clinical settings as measured by patient outcomes. Additionally, a better understanding of the systematic barriers to adoption of obesity pharmacotherapy is necessary.

The study* and its accompanying commentary are published in the September issue of Obesity, the scientific journal of The Obesity Society.

*Disclosure: The authors of this research were given access to the prescription databases through a partnership with Vivus, Inc.

1. http://www.obesity.org/content/weight-diabetes

This article originally appeared on The Obesity Society Web site. To learn more, click here.