Nadglowski, Murdoch: Medicare must catch up with obesity science – Daily Independent

By Joseph Nadglowski and Lisa Murdoch

At a time when scientific advances are rapidly deepening our understanding of how to treat complex diseases, health policies must keep pace. Obesity is a prime example of a complex disease at a tipping point. Despite monumental advances in medical science, Medicare policies do not cover comprehensive treatments for the millions of Americans living with obesity.

The Centers for Medicare & Medicaid Services’ outdated coverage limits ignore significant advances in obesity treatment that can reduce the risk of other health complications, including diabetes, hypertension and heart disease. It is beyond time that Medicare policy be updated to provide coverage for obesity drugs and other effective treatment options for this chronic disease and the 41.9% of Americans living with it.

Obesity and diabetes are closely related. Obesity accounts for up to 53% of new cases of type 2 diabetes. Characterized by the body’s inability to use insulin well, people with type 2 diabetes often have elevated blood glucose (blood sugar) levels, which can have serious health consequences.

Preventing and managing obesity is critical not only to reduce the risk of developing diabetes, but also to avoid other diseases such as heart disease and hypertension. Health care providers can play a vital role in prevention strategies by offering regular screenings for obesity-related risks, providing education about the importance of maintaining a healthy weight, and offering comprehensive treatment plans that include a combination of obesity medications and intensive behavioral therapy.

The significant medical breakthroughs we are seeing in obesity care are changing the paradigm of how we treat and manage the condition and are empowering vulnerable populations that have long suffered from inequality, stigma and barriers to effective care to manage their health. Recent years have seen groundbreaking innovations in obesity treatment targeting health conditions and risks directly related to excess weight. These innovative drugs have demonstrated outstanding efficacy and safety profiles of a new generation of obesity drugs.

These drugs are approved by the Food and Drug Administration for long-term use for chronic weight management or to reduce excess body weight and maintain weight reduction. In March 2024, the FDA approved one such drug to treat cardiovascular disease risks (heart attack, stroke, and death) for obese adults with a history of cardiovascular disease, making it the first obesity drug to receive such approval . Almost all FDA-approved obesity medications have been shown to improve glycemia in people with type 2 diabetes and delay progression to type 2 diabetes in at-risk individuals.

While our understanding of obesity and how to treat the disease has evolved to benefit affected populations, Medicare has failed to keep up with the science and recognize that obesity is a chronic disease. CMS still bars Medicare coverage of prescription anti-obesity drugs, citing an outdated federal law that excludes agents used for weight loss or weight gain. This paradigm is based on a prosaic understanding of the causes of obesity and a response to efforts to avoid providing access to weight loss supplements for cosmetic purposes only.

In addition, the national determination of coverage for intensive behavioral therapy for obesity is overly restrictive for types of health professionals and care facilities, significantly limiting and even undermining patient access to comprehensive services. CMS’s positions on obesity drugs and intensive behavioral therapy are increasingly unwarranted given the widespread recognition of obesity as an independent, complex disease by federal agencies, reputable scientific medical guidelines, and states that have already adopted policies to offer broader coverage for comprehensive care and treatment of obesity.

The consequences of inadequate access to obesity care and treatment are profound. Obesity-related diseases are the leading causes of preventable deaths. By 2030, half of the American population is projected to be living with obesity, which disproportionately affects vulnerable groups, including the elderly and minority communities. Addressing obesity comprehensively and proactively can significantly reduce other health care costs, as shown by a Veterans Health Administration study showing significant reductions in medical care costs from the use of obesity medications combined with lifestyle modification programs.

Earlier this year, the Obesity Action Coalition and the American Diabetes Association joined 56 national organizations representing people with obesity, their caregivers, seniors and other communities in calling on the administration to recognize obesity as a chronic disease and to expand the scope of comprehensive obesity treatment and care. Aligning Medicare policies with current scientific understanding and public health imperatives will greatly improve the quality of life for countless people and promote a healthier future for all.

In Congress, the House Ways and Means Committee took an initial step toward closing obesity care and treatment gaps for Medicare beneficiaries by passing an amended Obesity Treatment and Reduction Act. We urge the House and Senate to find a way in 2024 to address the obesity epidemic among people on Medicare.

Editor’s note: Joseph Nadglowski is president and CEO of the Obesity Action Coalition. Lisa Murdoch is the Chief Advocacy Officer at the American Diabetes Association. Reader reactions, pro or con, are welcome [email protected].