Time to address obesity as a priority for Medicare

When we think of the health problems that tend to affect us in our senior years, arthritis immediately comes to mind.  So do cognitive disorders, such as dementia or Alzheimer’s disease.  And, of course, there is a greater likelihood of the need for joint replacements as we get older.

A serious medical condition that society seldom associates with advanced age is obesity.  However, obesity among the over-65 population is a prevalent problem, approaching crisis levels.  Today, approximately one of every four seniors in the United States, according to the Gallup-Healthways Well-Being Index, has a body mass index that categorizes them as obese.  In fact, between 2008 and 2014, obesity among older Americans increased at a greater rate than for any other age group.

{mosads}This is not just a statistical problem.  It’s a particularly lethal one.  Recent research has shown that for those who are over 65 and obese, the risk of mortality further increases as their weight continues to climb.  The evidence is clear.  Obesity at an older age carries with it significant health problems, including diabetes and heart disease, and increases the probability of premature death.

Thus, it is important that we take a hard look at the way Medicare is protecting the health and well-being of its beneficiary population.  At first glance, it would appear that efforts have been made to help seniors with obesity-related issues.  Through Medicare Part B, seniors can receive free obesity screenings and (for those with a body mass index that falls within the obesity category) up to 22 counseling sessions providing weight monitoring as well as diet and exercise guidance.

There are flaws, however, with this approach.  First, these counseling sessions are covered only when provided by primary care physicians, not by dieticians or nutritionists with more relevant training.  Second, regardless of weight loss counseling, there is only so much that an older person with limited mobility and multiple chronic health conditions can do to exercise to help keep the weight off.  It’s perhaps not surprising that, in 2013, only 50,000 seniors of the millions facing obesity issues took advantage of Medicare’s weight loss counseling option.

The American Medical Association, after careful consideration, has classified obesity as a disease, and Medicare should certainly follow suit.  This would mean making weight loss medications that have proven to be safe and effective more readily available to Medicare beneficiaries.

Currently, the Medicare Part D prescription drug program prohibits coverage of medications to treat obesity.  This is a long-standing Medicare policy, refusing to pay for weight gain or weight loss pharmaceuticals that were once thought of as “lifestyle” drugs.  Policy makers need to change this way of thinking.  Seniors don’t need obesity drugs for vanity purposes.  They need them to stay alive.  They need these medications to prevent damage to their hearts, kidneys, lungs, and joints.  Obesity has a dramatic negative effect on almost every major chronic disease associated with aging, leading to significantly higher health care costs as patients try to manage these other conditions. 

In addition to health objectives, Medicare should review its approach to obesity treatments for financial reasons.  Yes, there are short-term savings in limiting seniors’ access to weight loss medications.  The trade-off for this policy, however, is a senior population that will have a significantly greater need for hospital stays, acute care, expensive procedures, and emergency room visits.  The long-term costs of an unwell beneficiary population are exorbitant.

The prevalence of obesity among seniors is a health crisis that has received too little attention.  It’s very real, though, and worsening.  Bringing Medicare into the 21st century is a necessary step in addressing obesity-related health issues for our nation’s over-65 population.

Appleby is executive director and chief executive officer of the Gerontological Society of America (GSA).