Obesity Deemed an Illness

Washington TimesObesity deemed an illness

Obesity is now an illness and can be covered by Medicare, the federal health-insurance program for the elderly and disabled. Health and Human Services Secretary Tommy G. Thompson announced yesterday the Centers for Medicare and Medicaid Services would remove language in Medicare’s coverage manual that states obesity is not an illness. “Obesity is a critical public health problem in our country that causes millions of Americans to suffer unnecessary health problems and to die prematurely,” Mr. Thompson said at a hearing yesterday of the Senate Appropriations labor, health and human services, and education subcommittee. The move stops short of classifying obesity as a disease.

Is smoking an illness? Drunkenness? Reckless driving? Heroin consumption? They all cause people to “suffer unnecessary health problems and to die prematurely,” too.

Sixty-four percent of the U.S. population is overweight or obese, according to the Centers for Disease Control and Prevention. Obesity contributes to diseases such as diabetes, hypertension, stroke and sleep apnea.

Sounds like a lot of people need to get more exercise and make more healthy dietary choices.

The change means Medicare participants may ask for reimbursement for treating excessive weight. Anyone with a body mass index of 30 or higher is considered obese, and those with an index of 25 to 29 are considered overweight. A healthy body mass index is 19 to 25.

If we change the definitions again, we can cure lots of disease!

Patients are not guaranteed automatic coverage for treatment. Medicare will review the requests, which could range from joining a weight-loss or fitness club to surgeries and counseling, and their rates of success before granting coverage. Weight-loss drugs will not be covered, because the law creating the Medicare prescription program, which starts in 2006, prohibits the program from paying for those medications.

The decision to stop short of classifying obesity as a disease limits how much treatment Medicare must cover. Suggested obesity treatments must meet higher standards than medical interventions for diseases, which must be included in coverage. By law, Medicare covers only medically necessary services for injury or illnesses. The coverage manual had stated obesity was not an illness, meaning nutritional and behavioral counseling were not covered.

So, gym fees are covered if you’re fat, but not if you’re thin and just want to stay healthy? How does that make sense? And, if going to the gym can cure it, is it really an illness?

Obesity-related illnesses already are expanding the nation’s health care expenses and costing businesses an estimated $17 billion, according to the CDC. “With this new policy, Medicare will be able to review scientific evidence in order to determine which interventions improve health outcomes for seniors and disabled Americans who are obese and its many associated medical conditions,” Mr. Thompson said. Although Medicare officials said it was too early to estimate the number of requests the policy change would bring, several business groups said they are worried that the swelling number of Medicare participants eligible for the coverage will increase health insurance costs.

Small businesses probably would see the largest rate increases, said Helen Darling, president of the National Business Group on Health, a Washington nonprofit for about 219 businesses and health care insurers. Although unions and companies with more than 500 employees are big enough to decide which health options they will cover, small businesses must buy insurance packages that have minimum coverage requirements specified by the states, Ms. Darling said. More small businesses could drop health plans altogether if states required additional obesity coverage that push up overall rates, she said. “Unfortunately, regulators love to put in mandates they are not stuck paying for,” Ms. Darling said.

Washington taxpayer advocacy group Citizens Against Government Waste called the decision “groundbreaking” in its implications. “We can expect Medicare costs to be even more obese and out of control than they already are while the taxpayer is footing the bill,” said Elizabeth Wright, health and science division director. Medicare for 41.3 million beneficiaries cost $274 billion last year, according to the Congressional Budget Office. With 64 percent of the American population overweight or obese, a substantial percentage of Medicare participants probably would qualify, spelling trouble for the program, Ms. Wright said.

Trial lawyers also may use the policy change as another weapon in their arsenal against the food and restaurant industries, Ms. Wright added. Several lawyers have filed lawsuits against the industries trying to blame them for America’s weight problem. America’s Health Insurance Plans, a Washington trade association for the industry, said its 1,300 members welcomed the policy change.

So, we’ve got an “illness” that two-thirds of the population suddenly has. The result of which is going to be radically higher health care costs and more lawsuits, which will also drive up health care costs. The upshot of which, almost certainly, is that a lot of people will no longer be able to afford health insurance. This makes sense, how, exactly?

For more coverage, see:

WaPo – Medicare Changes Policy on Obesity

Eighteen percent of the Medicare population is obese, according to the American Obesity Association, a nonprofit advocacy group. From 1991 to 1998, the prevalence of obesity among people ages 60 to 69 increased 45 percent, the association said.

Interesting. So, while the illness affects 64% of Americans overall, it only gets 18% of the elderly?

NYT – A Deletion Opens Medicare to Coverage for Obesity

In addition to the practical implications of getting insurance to pay for more treatment, many experts said the move would help counter the stigma that is often associated with people who are overweight and obese. That might encourage more doctors to treat the problem like other medical conditions and overweight individuals to seek help, experts said. “The lack of recognition of obesity as a disease has cast a pall over the field. Now Medicare is saying obesity deserves treatment like any other disease,” said Louis J. Aronne, president-elect of the North American Association for the Study of Obesity.

The decision was denounced by critics who contend that the health consequences of being overweight have been exaggerated and any real problem is one of individual responsibility.
“This is truly a dumbing-down of the term ‘disease.’ This is the only disease that I’m familiar with that you can solve by regularly taking long walks and keeping your mouth shut,” said Rick Berman, executive director of the Center for Consumer Freedom, a food-industry-funded advocacy group. “It’s terrible to start using taxpayer money like this when there are other legitimate diseases that need to be addressed.”

The decision is irrational, given that being underweight is more of a health problem for the elderly than being overweight, said Paul F. Campos of the University of Colorado, who wrote a recent book titled “The Obesity Myth.” “It’s not just a bad idea — it’s completely unscientific,” Campos said. “We’re in the grip of a kind of out-of-control cultural hysteria on this issue that leads to really irrational social decisions, such as making obesity a disease among the elderly.”

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James Joyner
About James Joyner
James Joyner is Professor and Department Head of Security Studies at Marine Corps University's Command and Staff College. He's a former Army officer and Desert Storm veteran. Views expressed here are his own. Follow James on Twitter @DrJJoyner.


  1. Mark says:

    Blog-reading is an addiction! I want my government subsidized computer (complete with flat-screen monitor) right now.

  2. Mike says:

    My goal is to gain 20 pounds a month for the next three months so I don’t have to pay for my gym membership any more; Gold’s is expensive nowadays.

    Germany, France, socialism here we come.

    Death to personal responsibility; let the government take care of you.

  3. Joseph Marshall says:

    As usual on the health care issue, everybody has missed the crucial point on this one. It is contained in the following phrase:

    “With this new policy, Medicare will be able to review scientific evidence in order to determine which interventions improve health outcomes for seniors and disabled Americans who are obese and its many associated medical conditions,” Mr. Thompson said.

    As someone with intimite contact with Medicare from the consumer’s point of view (my lady companion is on total disability) I can tell you the REAL meaning of the above coded phrase.

    We ARE treating obesity in this country, we merely label it by its secondary complications: heart disease, sleep apnea, diabetes type II, and so on. Virtually any “review” of treatment options by Medicare is, and has been since 1980, merely a hunting expedition to find those options for which any excuse can be drummed up to cut or eliminate coverage.

    The shell game goes like this. When “obesity” was not recognized by Medicare, the intelligent preventative treatments–diet, exercise, ect.–were “not medically necessary”.

    Now that this language is being abandoned, a whole host of treatments for other diseases with medically valid diagnoses can be bureaucratically reclassified as “due to obesity” and therefore a “non-covered expense”, just like diet, exercise, and so forth.

    So don’t expect any taxpayer money spent for Jenny Craig or Victory Fitness anytime soon.