Covering Preventive Services and Obesity

Starting September 23, 2010, new private health policies will be required to cover preventive services “that have strong scientific evidence of their health benefits” and eliminate cost-sharing requirements for such services.   According to HHS Secretary Kathleen Sebelius:  “From the Recovery Act to the first lady’s ‘Let’s Move Campaign’ to the Affordable Care Act, the administration is laying the foundation to help transform the health care system from a system that focuses on treating the sick to a system that focuses on keeping every American healthy.”  This requirement was promulgated by HHS, Labor and Treasury departments.

Preventive services such as breast and colon cancer screenings, screening for vitamin deficiencies during pregnancy, screenings for diabetes, high cholesterol and high blood pressure, and tobacco-cessation counseling will be covered under these rules, according to HHS, as well as routine vaccines and certain preventive services for women and children.

Let’s now shift our thoughts to a recent report from the Robert Woods Johnson Foundation and the Trust for America’s Health, “F as in Fat.”   The report contains policy recommendations, aimed primarily at coordinating the government’s response to the epidemic of obesity.  Nearly 10% of health costs are linked to obesity. 

 

The report included the following rates of obesity by state:

 

State Obesity Rates for Adults

1. Mississippi 33.8%
2. Alabama 31.6%
3. Tennessee 31.6%
4. West Virginia 31.3%
5. Louisiana 31.2%
6. Oklahoma 30.6%
7. Kentucky 30.5%
8. Arkansas 30.1%
9. South Carolina 29.9%
10. North Carolina 29.4%
10. Michigan 29.4%
12. Missouri 29.3%
13. Ohio 29.0%
13. Texas 29.0%
15. South Dakota 28.5%
16. Kansas 28.2%
17. Pennsylvania 28.1%
17. Georgia 28.1%
17. Indiana 28.1%
20. Delaware 27.9%
21. North Dakota 27.7%
22. Iowa 27.6%
23. Nebraska 27.3%
24. Alaska 26.9%
24. Wisconsin 26.9%
26. Illinois 26.6%
26. Maryland 26.6%
28. Washington 26.3% 
29. Maine 25.8%
29. Arizona 25.8%
31. Nevada 25.6%
32. Virginia 25.5%
32. Minnesota 25.5%
32. New Mexico 25.5%
35. New Hampshire 25.4%
36. New York 25.1%
36. Florida 25.1%
36. Idaho 25.1%
39. Oregon 25.0%
39. Wyoming 25.0%
41. California 24.4%
42. New Jersey 23.9%
43. Montana 23.5%
44. Utah 23.2%
45. Rhode Island 22.9%
46. Vermont 22.8%
47. Hawaii 22.6%
48. Massachusetts 21.7% 
49. D.C. 21.5%
50. Connecticut 21.4%
51. Colorado 19.1%

The report revealed these key findings: 

• For the sixth year in a row, Mississippi topped the scales. A 33.8 percent rate of adult obesity made the Magnolia state the worst in the nation.
• Tied for second were Alabama and Tennessee, followed respectively by West Virginia, Louisiana, Oklahoma, Kentucky, Arkansas and South Carolina.
• North Carolina tied the only Northern state to make the top ten—Michigan—for tenth place in terms of highest levels of adult obesity, with a rate of 29.4 percent.
• Mississippi was also worst for obesity among children aged 10-17, with a whopping 21.9 percent of children being seriously overweight.
• Louisiana, Tennessee, Kentucky, West Virginia and Arkansas were all in the top ten for childhood as well as adult obesity—but Oklahoma, Michigan, and the Carolinas were replaced here by Illinois, Texas, Georgia and, oddly, Washington, D.C. 
• The states who fared best on adult obesity are concentrated in the north and west, with Colorado, Connecticut and Washington D.C. leading the pack, followed by Massachusetts, Hawaii, Vermont, Rhode Island, Utah, Montana and New Jersey. While it may seem unusual that D.C. would be in the top ten best places for adult obesity and ten worst for children, because it is really a city not a state, it’s hard to make truly reliable comparisons.

 

As 10% of healthcare costs are linked to obesity, the following questions arise:

• Should health plans cover dietary counseling for members who are obese? 
• Should health plans provide discounted memberships to health clubs?
• Why aren’t these services or others aimed at addressing obesity included in the list of preventive services covered under the new regulations?

Of course, this is America.  Why should we take responsibility for our own weight and health when we can have others assume responsibility for us?   Why should we take responsibility for our own weight and health through self-discipline, diet and exercise when we can simply pop a pill?

Another story released today is that a weight-loss pill called lorcaserin not only helps people drop pounds but does so with few side effects.

Lorcaserin is a new type of weight-loss drug that works by acting on serotonin, a chemical associated with feelings of well-being and feeling full, and does not appear to increase blood pressure or cause any other heart problems, according to an article published in the July 15 issue of the New England Journal of Medicine.  The study was sponsored by Arena Pharmaceuticals, of San Diego, Calif., which used its own doctors as part of the study group.

The drug is one of three new anti-obesity drugs being considered for approval by the U.S. Food and Drug Administration. On Thursday, an FDA advisory panel is expected to review Qnexa, made by Vivus, from a combination of phentermine and topiramate. It helped patients in clinical trials lose as much as 13 percent to 15 percent of body weight.

FDA briefing documents posted online Tuesday acknowledged Qnexa’s effectiveness in helping patients lose weight, but said the review panel should take into account a number of potential nervous system and psychiatric side effects, the Associated Press reported.

The third new drug is Orexigen Therapeutic’s Contrave, which is a combination of the antidepressant Wellbutrin and the addiction drug naltrexone.

According to the Associated Press, lorcaserin will be reviewed by an FDA panel in September, and Contrave will be reviewed in December.

Personally, popping a pill is not the answer.  Compliance and persistence rates with pharmacotherapy, regardless of the drug category, are remarkably low.  Popping a pill does not address muscle tone, heart strength, stamina and other benefits of a regular exercise program.  Covering dietary education and support groups, encouraging exercise and a good dose of self-responsibility and discipline are more effective solutions.  Perhaps the new payer regulations will be expanded to include these approaches.