Few senior citizens benefiting from
Medicare obesity counseling
Affordable Care Act added Medicare
benefit offering face-to-face weight-loss counseling to 13 million obese
seniors in the U.S.
VarneyFebruary 23, 2015
23, 2015 - In the farming town of Exeter, deep in California’s Central
Valley, Anne Roberson walks a quarter mile down the road each day to her
mailbox. Her walk and housekeeping chores are the 68-year-old’s only
exercise, and her weight has remained stubbornly over 200 pounds for
some time now.
“You get to a certain point in your
life and you say, ‘What’s the use?’”
For older adults, being mildly
overweight causes little harm, physicians say. But too much weight is
especially hazardous for an aging body: Obesity increases inflammation,
exacerbates bone and muscle loss and significantly raises the risk of
heart disease, stroke, and diabetes.
Dr. Mylene Middleton Rucker, a
primary care physician in Visalia, Calif., is using the new obesity
counseling benefit with her patients, but many doctors aren’t aware of
it yet. (Sarah Varney/KHN)
To help the
13 million obese seniors in the U.S., the Affordable Care Act
included a new Medicare benefit offering face-to-face weight-loss
counseling in primary care doctors’ offices. Doctors are paid to provide
the service, which is free to obese patients , with no co-pay. But only
50,000 seniors participated in 2013, the latest year for which data is
“We think it’s the perfect storm of
several factors,” says Dr. Scott Kahan, an obesity medicine specialist
at George Washington University. Kahan says obese patients and doctors
aren’t aware of the benefit, and doctors who want to intervene are often
reluctant to do so. It’s a touchy subject to bring up, and some hold
outmoded beliefs about weight problems and the elderly.
“It used to be thought that older
patients don’t respond to treatment for obesity as well as younger
patients,” Kahan says. “People assume that they couldn’t exercise as
much or for whatever reason they couldn’t stick to diets as well. But
we’ve disproven that.”
Weight loss specialists place the
blame for poor awareness of the new benefit on the federal government’s
decision to limit counseling to primary care offices.
“The problem with using only
primary care providers,” says Bonnie Modugno, a registered dietician in
Santa Monica, California, “is that they completely ruled out direct
reimbursement for the population of providers who are uniquely qualified
and experienced working with weight management. I think that was a big
mistake.” She was referring to registered dieticians like herself, as
well as specialists such as endocrinologists, who might be managing a
person’s diabetes, and cardiologists, who monitor patients with heart
disease. Both conditions can be caused by or made worse by excess
The drafters of the health law
deliberately wrote the benefit narrowly out of concerns about widespread
fraud, if charlatans were able to bill Medicare for obesity counseling.
Modugno says she is sympathetic to that concern, but it is too
restrictive as enacted.
“Unless we change the nature of
how…the counseling occurs, I don’t see it being available to people in a
meaningful way,” said Modugno.
As for Anne Roberson, she says the
extra weight she has long carried on her petite frame has begun taking a
toll on her joints, her sleep and her mood. On a recent morning,
Roberson listened politely to her longtime physician, Dr. Mylene
Middleton Rucker, during her first Medicare weight-loss counseling
session. Rucker suggested she eat more vegetables and less meat and
encouraged her to join an exercise class.
Rucker, who is obese herself, says
she doesn’t expect her older patients to lose a lot of weight. “I think
you’ll see weight loss of 10 to 20 pounds, but whether you’re going to
see people lose 50 to 100 pounds as they’re older, I doubt it.”. Still,
Rucker says, even with small amounts of weight loss in her older
patients, she expects to see a decrease in the complications of chronic
medical diseases, including diabetes-related leg amputations.
Roberson says she has tried to lose
weight before, but “you hit a couple of rough weeks and you kinda slough
off.” This time, Roberson says firmly, she will have to come back and
answer to Rucker.
KHN’s coverage of aging and
long term care issues is supported in part by a grant from
The SCAN Foundation.
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