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Medicare Coverage of Obesity Treatments Won't Be Immediate

Evaluation of medical evidence must take place first, officials say

FRIDAY, July 16, 2004 (HealthDayNews) -- While health experts are applauding the decision to allow Medicare coverage of treatments for obesity, that coverage probably won't take effect until next year, officials said.

What must come first is a thorough review of clinical trial data showing that a given treatment -- anything from dietary counseling to surgery -- improves the health of the people who receive it, according to statements from officials at the U.S. Department of Health and Human Services' Centers for Medicare & Medicaid Services (CMS).

HHS Secretary Tommy G. Thompson announced Thursday a change in Medicare policy that specifically forbade coverage of obesity treatments because obesity wasn't classified as an illness. The new policy opens the way for treatment by declaring that obesity is indeed an illness.

CMS now awaits submission of clinical evidence on weight-loss treatments, CMS officials said. Evaluation of that evidence will determine whether Medicare will cover a treatment or not.

If necessary, CMS will turn to its medical advisory committee for advice on the quality of the evidence offered for a given treatment, officials said. Evaluation of clinical trials often takes months.

"As a first step, we expect to convene our Medicare Coverage Advisory Committee in the fall to evaluate the evidence on obesity-related surgical procedures that may reduce the risk of heart disease and other illnesses," Dr. Sean Tunis, CMS chief medical officer, said a statement.

Less drastic measures, such as dietary counseling, will also be considered, a fact that "makes us extremely excited," said Katherine Tallmadge, a spokeswoman for the American Dietetic Association.

"We have plenty of clinical trials showing the effectiveness of dietary and lifestyle changes," Tallmadge said. "We do have decades of scientific study. Our task is to translate peer-reviewed studies to clinical practice, using science to determine the best way to lose weight."

Obesity has been linked to a variety of health problems, including type 2 diabetes, heart disease and stroke, cancer, sleep apnea, osteoarthritis, gallbladder disease and liver disease.

Because many claims made for commercial weight-loss diets and products aren't backed by scientific studies, "it is critical that people seek qualified help to do this," Tallmadge said. Names of registered dieticians who have passed examinations given by the American Dietetic Association can be obtained from the association's Web site, she added.

The rules about obesity treatment for children covered by Medicaid differ from those governing older people in Medicare. Medicaid decisions are made by individual states, so some children may be eligible for coverage already.

The need for treatment of childhood obesity was emphasized in a federal report issued Friday on the well-being of American children. It cites a substantial increase in the incidence of childhood obesity -- from 5 percent in 1976 to 13 percent in 2002 for non-Hispanic whites, from 8 percent to 21 percent over the same period for blacks and from 16 percent in 1988 to 23 percent in 2002 for Mexican-Americans.

"This is a concern not just for the health of children but for those children when they become adults because overweight in childhood very strongly predicts obesity in adulthood," Dr. Duane Alexander, director of the National Institute of Child Health and Human Development, said during a teleconference.

Some obese older people have been receiving coverage for various medical problems related to their weight. Medicare policy has permitted coverage of treatments for what are called "comorbidities" -- conditions such as high blood pressure that are closely associated with obesity. That policy has permitted Medicare to pay for surgery for "morbidly obese" individuals, those whose weight puts their lives in danger.

More information

For more on obesity, visit the National Library of Medicine. A roster of registered dieticians is available from the American Dietetic Association.

SOURCES: Katherine Tallmadge, R.D., Washington, D.C.; U.S. Department of Health and Human Services, July 15, 2004; July 16, 2004, America's Children in Brief: Key National Indicators of Well-Being 2004
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