Government Initiatives on Obesity

The Endocrine Society Recognizes Recent Government Initiatives Aimed to Combat Obesity

In 2004, two major U.S. government agencies – the Department of Health and Human Services (HHS) and the Food and Drug Administration (FDA) – launched programs aimed at combating the epidemic of obesity in the U.S.

HHS joined with the Ad Council to educate Americans about taking small, achievable steps to improve their health, promote weight loss, and reverse the impact of obesity⁸⁶. The FDA’s campaign called, “Calories Count,” includes recommendations to strengthen food labeling, a consumer education component about maintaining a healthy diet and encouraging weight loss, and a push to restaurants urging them to provide information about nutritional value and caloric intake for all food served⁸⁷.

Although both the HHS advertising campaign and the FDA’s “Calories Count” initiative are commendable programs for combating obesity and promoting weight loss, they focus only on behavior changes, thereby telling only part of the story.

Diet and exercise are vitally important for combating the obesity epidemic, but for some people, they may not be enough. The Endocrine Society believes it is critical to help the American public understand not only the health risks associated with obesity, such as diabetes, hypertension, PCOS, hypothyroidism and heart disease, but also that obesity it is not always simply a behavioral condition.

Recognizing the many components contributing to obesity, in April 2003 the National Institutes of Health (NIH) established the NIH Obesity Research Task Force to develop a plan to enhance research-based efforts to address weight loss and the obesity epidemic. The resulting Strategic Plan seeks to uncover prevention and treatment approaches through lifestyle modification, surgical and pharmacologic approaches and through further examination of related health conditions. Additional research topics include health disparities, technology, interdisciplinary research teams, translational research, and education and outreach efforts.

Through important medical research, we begin to understand that obesity has many underlying causes of obesity, which may not be controlled by diet and exercise alone. We must move beyond stigma and dedicate ourselves to combating obesity on all fronts: behavioral, nutritional and metabolic.

How Does Obesity Impact Health Insurance Coverage?
According to a study conducted by Kaiser Permanente in the 1990s and published in 2004⁸⁸, a body mass index (BMI) > 30 directly impacts the average length of inpatient hospital stays, the quantity and cost of outpatient visits, and pharmacy and lab costs. The increase in costs associated with obesity is likely attributed to its complications – namely coronary disease, hypertension and diabetes.

Medicaid and Obesity⁸⁹
Medicaid is a government program that provides health insurance to qualified individuals whose income is below a certain level. In 29 states, pharmaceutical products indicated strictly for the treatment of obesity and weight loss are specifically excluded from state Medicaid programs, while in nine states – Alaska, California, Kentucky, Montana, North Carolina, Oregon, Rhode Island, Washington and Wisconsin – anti-obesity and weight loss pharmaceutical products are covered.

Under the national Omnibus Budget Reconciliation Act, a congressional act that funds state programs to provide pharmaceutical products to Medicaid recipients, a state may decide to restrict drugs or classes of drugs, or their medical uses, for certain purposes. A state choosing to include outpatient drugs within its Medicaid program must cover, for their medically accepted indications, all FDA-approved prescription drugs of manufacturers that have entered into drug rebate agreements. With limited exceptions, this agreement includes drugs, when used:

• for anorexia, weight loss or weight gain;
• to promote fertility;
• for cosmetic purposes or hair growth;
• for symptomatic relief of cough and colds; and
• to promote smoking cessation.

Medicare and Obesity⁹⁰
Medicare, a government program that provides health insurance coverage to the elderly and disabled, excludes coverage of hospital and physician services for obesity and weight loss. The Medicare Coverage Manual explains this exclusion by defining obesity as a condition that, by itself, cannot be considered an illness. Medicare’s position is that the origin of obesity is a caloric intake persistently higher than caloric output.

Although obesity is not in itself an illness according to the Medicare Coverage Manual, and is therefore not covered, obesity resulting from other covered illnesses is provided for under the Medicare program. In the instances when obesity aggravates or causes cardiac and/or respiratory diseases, diabetes or hypertension, treatment services are covered under the Medicare program.

NOTE: As of press time, a revised Medicare plan was being debated in Congress. Modifications in coverage may be incorporated once the revisions are approved.

How Can Losing Weight Impact Your Tax Return?
Obese Americans who take action, under the care of a physician, to engage in weight loss now have the option to deduct expenses for approved weight-loss regimens, drugs and nutritional counseling. According to the IRS, weight loss deductions are now allowed for unreimbursed expenses for weight loss treatment if the cost is more than 7.5 percent of adjusted gross income. Although the agency designated obesity as a disease in April 2002, the ruling does not define the condition, but rather requires a doctor's diagnosis before the obesity surgery or weight loss or nutrition counseling costs can be deducted. Prior to the IRS designating obesity as a disease, Americans were only able to claim the cost of weight loss programs that were recommended by a physician to treat a specific disease associated with obesity.