ABSTRACT
Obesity and the growing population of older adults are significant public health concerns in the United States. In 2011, the Centers for Medicare and Medicaid Services introduced a Medicare benefit for obesity counselling using Intensive Behavioral Therapy that would reimburse structured visits over a 12-month period. Although we applaud this new benefit that addresses the obesity epidemic in older adults, three major shortcomings limit its utility and potential effectiveness: 1) weight loss interventions differ in older and younger adults, yet the benefit relies predominantly on data from interventions studied in younger populations; 2) body mass index is not an accurate measure for identifying obesity; and 3) tying reimbursement to clinician visits may hamper the integration of this benefit into practice. To overcome these shortcomings, we propose: 1) obesity treatment should focus on improving quality of life and physical function and on mitigating muscle and bone loss rather than focusing solely on weight loss; 2) waist circumference or waist-hip ratio should be considered as additional anthropometric measures in ascertaining obesity; and 3) allied health professionals should be reimbursed for providing this benefit. Incorporating these suggestions will improve its usability in clinical practice and increase the chances that this well-meaning benefit will improve patient outcomes.
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Abbreviations
- BMI:
-
Body mass index
- CMS:
-
Centers for Medicare and Medicaid
- USPSTF:
-
United States Preventive Services Task Force
- WC:
-
Waist circumference
- WHR:
-
Waist-hip ratio
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Acknowledgements
Funding
Supported in part by the Dartmouth Centers for Health and Aging, and the Department of Medicine, Geisel School of Medicine at Dartmouth-Hitchcock Medical Center.
Conflicts of Interest
JA Batsis—Received prize for the American Geriatrics Society/Merck New Investigator Award 2014.
KL Huyck—None.
SJ Bartels—Receives funding from the National Institutes for Mental Health and the Centers for Disease Control.
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Batsis, J.A., Huyck, K.L. & Bartels, S.J. Challenges with the Medicare Obesity Benefit: Practical Concerns & Proposed Solutions. J GEN INTERN MED 30, 118–122 (2015). https://doi.org/10.1007/s11606-014-3031-6
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DOI: https://doi.org/10.1007/s11606-014-3031-6