title: Challenges with the Medicare obesity benefit: practical concerns & proposed solutions.
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.
authors.affiliation: Section of General Internal Medicine, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, 03756, Lebanon, NH, USA, john.batsis@gmail.com.
authors.forename: John A
authors.initials: JA
authors.lastname: Batsis
authors.forename: Karen L
authors.initials: KL
authors.lastname: Huyck
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Bartels
mesh_terms: D000367:Age Factors; D000886:Anthropometry / Q000379:methods; D001521:Behavior Therapy / Q000191:economics / Q000379:methods; D015992:Body Mass Index; D006801:Humans; D006278:Medicare; D009765:Obesity / Q000503:physiopathology / Q000628:therapy*; D020399:Practice Management / Q000458:organization & administration; D011788:Quality of Life; D012052:Reimbursement, Incentive; D014481:United States; D015431:Weight Loss / Q000502:physiology