comparison, about 250,000 seniors last year used Medicare’s tobacco
cessation counseling benefit, which started in 2005 and offers greater
flexibility about how providers can offer it.
percent of seniors smoke, while 30 percent are obese.
smoking are the two leading causes of preventable death in the United
States. Obesity, which is defined as being 35 pounds or more overweight
or having a body mass index above 30, increases the risk of many
diseases, including diabetes, heart disease and cancer.
physicians typically offer little more than lip service to helping
patients lose weight.
little or no training in weight loss in medical school or residency
training, and many doctors tend to view obesity as a matter of
appearance and self-control, instead of health,” said Kahan, director of
the Strategies to Overcome and Prevent Obesity Alliance, a coalition
working to combat obesity.
many of the most knowledgeable providers are not even eligible to
participate. For instance, Kahan, a board-certified doctor in preventive
medicine, obesity medicine and clinical nutrition, is excluded. That’s
because only primary care providers and nurse practitioners or physician
assistants working in doctors’ offices, can be reimbursed under the
officials say they did that so weight loss counseling could be
coordinated with the rest of a patient’s health care. Yet, critics say,
the policy cuts out providers with deeper expertise in weight loss, most
notably, registered dieticians, diabetes nurse educators, psychologists
and obesity medicine specialists. Bills have been introduced in Congress
to expand the list of those eligible to participate, but they have gone
challenge is the requirement that counseling be provided during a
separate appointment, rather than when the patient comes in for other
problem for Dr. Reid Blackwelder, board chairman of the American Academy
of Family Physicians, who has many obese seniors in his practice in
Kingsport, Tenn. But he’s yet to offer obesity counseling because of the
burden of bringing patients in for a separate visit. “That is not how
family doctors work,” he said. “It’s not the best use of my time.”
deterrent is that Medicare pays doctors about $26 for a 15-minute
counseling session. Many primary care doctors can earn three or four
times that delivering other services.
too many other competing priorities, and Medicare beneficiaries have so
many other medical problems that obesity tracks down to last on the
priority list,” said Dr. Robert Kushner, clinical director of the
Northwestern Comprehensive Center on Obesity in Chicago.
government has done little to publicize the benefit. A spokeswoman for
the Centers for Medicare & Medicaid Services said there has been no
publicity except for a mention in the Medicare handbook mailed to
doctors shy away from discussing obesity issues, regular counseling
sessions done in a physician’s office do increase the likelihood of
weight loss, according to a 2011 study in the New England Journal of
published in the journal Obesity, which was cited by the
government when it launched the new benefit, found counseling along with
dietary and exercise changes can produce average weight loss of 7 to 8
pounds over one to three years and the change improved blood sugar
levels and mobility and reduces the incidence of diabetes.
It worked for
Randall Roberts, an 86-year-old retired banker in Valparaiso, Fla., who
said he lost 32 pounds after starting counseling at his physician’s
office in 2012. He’s now down to 187 pounds and credits his physician’s
constant encouragement to change his eating and exercise habits.
“I did not
have stamina to go on long walks but he encouraged me to get back on my
treadmill,” he said.
food helped him cope after his wife passed away a few years ago. Today,
he’s learned to cut out fast food, eat salads without fattening ranch
dressing and look to nuts for snacks.
McKnight, Roberts’ family physician in Niceville, Fla., said he and his
staff have provided weight loss counseling to about 30 Medicare patients
in the past three years —those who they deem motivated to change.
doctors won’t get rich providing the benefit but “when you break it
down, the $26 is not as bad a hit as it may seem.” He stresses to
patients that weight loss is a gradual process done through small steps,
such as limiting portion size and eliminating sodas.
Herrlinger, 74, a retired marketing manager in Santa Rosa Beach, Fla.,
who calls himself “a former fat guy,” said McKnight taught him the
importance of keeping a diary of everything he eats and of exercising.
He has lost 35
pounds in the past year and his diabetes is now under better control,
along with his cholesterol. “I’m glad to see Medicare step up and offer
this because the country is really obese and the cheeseburger generation
is marching in.”
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