Federal panel recommends intensive counseling for obese adults
By Melissa Healy, Los Angeles Times -
WASHINGTON — In a move that could significantly expand insurance coverage of weight-loss treatments, a federal health advisory panel on Monday recommended that all obese adults receive intensive counseling in an effort to rein in a growing health crisis in America.
The U.S. Preventive Services Task Force urged doctors to identify patients with a body mass index, or BMI, of 30 or more — currently one in three Americans — and either provide counseling themselves or refer the patient to a program designed to promote weight loss and improve health prospects.
Under the current health care law, Medicare and most private insurers would be required to cover the entire cost of weight-loss services that meet or exceed the task force’s standards.
That could all change Thursday, when the U.S. Supreme Court is expected to rule on the constitutionality of President Barack Obama’s health care law, which requires adoption of certain strong recommendations from the task force, such as this one on obesity.
Few private health insurers now reimburse physicians for weight-loss counseling or pay for programs that patients seek out on their own. A growing number, in fact, charge obese patients more for coverage — a policy some public health officials have denounced as punitive and ineffective.
The Task Force concluded after a review of the medical literature that the most successful programs in improving patients’ health are “intensive, multi-component behavioral interventions.” They involve 12 to as many as 26 counseling sessions a year with a physician or community-based program, according to the panel.
Successful programs set weight-loss goals, improve knowledge about nutrition, teach patients how track their eating and set limits, identify barriers to change (such as a scarcity of healthful food choices near home) and strategize on ways to maintain lifestyle changes, the panel found.
In some cases, programs include exercise sessions as well.
The recommendation, published online in the Annals of Internal Medicine, does not apply to the roughly one-third of Americans who are considered overweight, those with a BMI from 25 to 29.9.
It follows a November decision by Medicare to reimburse physicians for providing “intensive weight counseling” to the roughly 14 million obese Americans insured by that government program.
The new guidelines were met with cautious support by many physicians at the front lines of the nation’s struggle against excess fat.
Dr. Jack Der-Sarkissian, a family-medicine specialist at Kaiser Permanente’s Los Angeles Medical Center, called them a “long-overdue” prod to physicians to help their patients control weight gain, which raises the risk for diabetes, heart disease and other health threats.
He cited a recent study that found that more than half of all obese patients had never been told by their physician that they needed to lose weight. “That’s just not fair to the patient,” said Der-Sarkissian, who leads Kaiser’s adult weight management efforts in Southern California.
“You have to diagnose the patient and have the discussion, even if the patient doesn’t really want to hear it,” he said.
But Jeffrey Levi, executive director of the nonpartisan think tank Trust for America’s Health, said the recommendations will put physicians in a difficult position: Few have the time or resources to provide obese patients with intensive counseling, he said.
The panel acknowledged that one problem with its recommendation was that no studies have shown such intensive programs provide long-term health benefits.
There appear to be short-term ones. Two studies cited by the panel found that patients who received intensive counseling were 30 percent to 50 percent less likely to have Type 2 diabetes two to three years later than those who received lighter counseling, drug therapy or both.
But the counseling subjects’ cholesterol numbers barely budged, and changes in blood pressure and waist circumference were, on average, small.
A pilot program considered a model by the task force is now being launched by the federal Centers for Disease Control and Prevention in 21 cities.
It is based on a clinical trial, known as the Diabetes Prevention Program, that encouraged modest improvements in food choices and at least 150 minutes of weekly exercise for participants, who were at high risk for developing diabetes.
The subjects, who typically met weekly for six months and monthly for the second half of the year, lost between 5 percent and 7 percent of their body weight and reduced their diabetes risk by 58 percent.
13 Responses to Federal panel recommends intensive counseling for obese adults
Leave a Reply
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
More Stories
- Grassley says doctors have a right to know how much doctors are paid by Medicare
- Supervisors hold weekly meeting Tuesday
- Cops break up fight at Timberland Park allegedly involving knife
- King Votes for the FY14 National Defense Authorization Act
- NIACC women’s golf team earns NJCAA academic all-American honors
- King Presents Medals to Vietnam War Veteran Robert Rohlfsen
- Iowa Congressman Tom Latham reacts to Obama’s threat to veto farm bill
- Branstad to sign Iowa Health and Wellness Plan Thursday in Mason City
- Branstad names D.T. Magee as interim director of the Iowa Department of Education
- Obama describes military deployments around the globe
- School Board approves levy to go to ballot Sept. 10th (VIDEOS)
- Obama calls leaders of United Kingdom, France, Italy and Germany
- White House reacts to presidential election in Iran
- Osage police warn of fraudulent letter, scam
- Report: Amanda Byrnes allegedly lunged at man, demanded his iPhone
- Spencer man headed to prison for 10 years for meth conspiracy
- Woman faked cancer to get out of jail
- Former BBC host, 83, sentenced to indecent assault on girls
- Minnesota Man Pleads Guilty to Deer Poaching Charges
- Personal Watercraft Incident Results in Fatality at Cedar Rapids
AS seen from here
June 30, 2012 at 4:09 pm
I’d rather die of obesity than starve to death.
SmrtGrl86
June 27, 2012 at 10:37 am
Normally I will not take time out of my day to argue to with people but this thread is disturbing.
I am glad those posting cruel and nasty comments on here are so faultless. I am sure you all have perfect bodies and therefore are deserving of being able to post anonymous nasty comments about faceless fat people that you do not know. I am also sure there is not one obese or overwieght person in your families, if there is I pitty them.
In the meantime this fat person has a few things to say. You know, just taking time out of my day of laying on the couch watching soap operas and eating potato chips. Since thats all fat people do anyway.
Not so much. This fat person spends her days mowing the lawn (with a push mower!), cleaning my house (which has stairs!), working in my four vegetable gardens (fat people eat vegetables!), bailing hay (small squares, no tractor to move them for me!), feeding and caring for livestock (not just eating them!), horseback riding (somebody call PEETA!), doing projects around the farm with my husband (OMG someone MARRIED a fat person?!), going to school part time (getting my fourth and fifth degrees!), working part time (at a job where I take care of sick people, and some of them are thin!)
Nor do I own a fry daddy, have baked goods hidden under my bed or have I eaten at a fast food joint or a buffet lately. I do; however, own a food dehydrator, a canner and several worn out pairs of shoes. My last hospital visit was not for diabetes, high blood pressure or cholesterol, it was for a broken bone, pretty hard to get one of those falling off of a couch.
But hey, who am I to stick up for myself and feel I am a worth while person. I have already been pronounced “disgusting”, “need to be charged by the pound”, “lazy” and I “stuff food in my face all day” Wow, you guys told me! You sound like the kids that picked on me as a teenager, when I was a normal weight according to my doctor but since the popular (anorexic) girls said I was fat and I wanted to fit in, I started dieting. Ten years of yo yo dieting later I am an obese adult who has made peace with thier body and is tired of trying to please the masses. I stay active, eat well and try to ignore idiots like you who would have every fat person shot in the street.
I hope you feel good about yourselves, being so active and perfect and all. I am sure you will find more negative things to say about my post, but I am going to go outside and do something now. You can do something too…like kissing my fat “lazy” ass.
LVS
June 27, 2012 at 2:34 pm
Well smart girl-I said most or almost, NOT all. There are people out there who are just naturally large. It’s their body style and that is all there is to it. That is why I do not like the body mass index. It assumes all people are the same. I am a person who is somewhat larger than I should be because I am handicapped I can’t exercise like I should and I must eat regular being a diabetic (it runs in my family). You sound like a girl who is very active and is happy with what she has. More power to you. However, I have no sympathy for the people that have had lap band surgery and then went back to their old habits.
REALLY
June 27, 2012 at 3:23 pm
Well smrtgrl86 I think I love you! You have stuck up for people who cant control weight issues. I never knew how many mean people are around here. But your right I feel sorry for there friends and family members having to live up to a narrow standard. Hope I dont know any of them. What a sad day…….
LVS
June 27, 2012 at 8:45 am
Most obese (fat) people or their own worst enemy’s because they can’t or won’t push away from the table and want to sit in front of the t.v. all day. All most of them need to do is put down the beer that they probably can’t afford and put out the cigarette’s and they will lose the weight and improve their health. Yes, it is true there are people out there with medical reasons for being obese but they are the majority. I know personally of three people who had lap band surgery at taxpayer expense and tow years later they are back drinking beer and eating fat foods and have put the weight right back on. For the most part it is lifestyle that causes these people to be fat and they want a mireical with out changing what they do.
LVS
June 27, 2012 at 8:47 am
I meant minority not majority. Sorry-it’s early in the day.
Anonymous
June 26, 2012 at 8:18 pm
Fat people are disgusting. If I see someone making fun of a handicapped person, I’ll step in and say something. To me, this is worth getting involved in. If I see someone making fun of a fat person, I’ll just laugh, point, and maybe throw in a comment or two myself. Most fat people don’t get that way because Neptune was not in line with Jupiter, or they were born during an unexpected meteor shower, or because a horse crossed east to west on a Wednesday night at two in the morning. They are the way they are because they can’t keep from stuffing food in their mouths every minute of every day.
Free Lunch
June 26, 2012 at 4:18 pm
Another free-lunch program in the making brought to you by the tax-payers.
Anonymous
June 26, 2012 at 4:15 pm
Observer: There you go again. Making excuses. You mention personalities, dual diagnosis, predisposition due to genetics. Tell me, which of those issues forced them to take that first drink or stuff that food in their face? In problem solving, there is something called the “root cause” of a problem. This is where you throw out all the excuse making and blame casting, and ask how this situation really developed. We have become a cuddly society, where we just want to hold the poor undertrodden person to our bosom and tell them it’s not their fault. Guess what, it really is there fault. Nobody just wants to admit it.
Kurt K
June 26, 2012 at 11:24 am
Personally I get tired of the larger people taking up more room. They should pay more to fly on an airplane for example. The airlines should charge by the pound.
Martha
June 26, 2012 at 10:52 am
It’s not always an obese person’s fault they are overweight. It may be a glandular issue, not always over eating. Therapy can’t cure everything.
Anonymous
June 26, 2012 at 11:21 am
Let obese people be evaulated. If medically treatable, fine. If it’s just a matter of these blimps unable to quit putting food in their mouths, let them rot. People are responsible for their own actions. Life is choices. Drug dependency – a disease, not. Alcohol addiction – a disease, not. Cancer, diabetes, parkinsons, these are diseases. When do people grow up and stop needing a baby sitter? For some of these losers, it’s never. And society keeps enabling them to continue. How did it start, and when is it going to stop?
Observer
June 26, 2012 at 12:27 pm
I think you had better do a bit more research into alcoholism and other dependencies before you say they are not a disease. Look at what they are, how they are manifest, and what personality types most are at-risk.
Some personalities have a tendency to switch from one addiction to another instead of addressing the root causes.
It is clinical fact, that many suffer dual-diagnosis (addiction and mental health), yet there are few facilities that address both modes sufficiently.
Questions of predisposition due to genetics, is not as far fetched as you might think. I recall articles on such subjects in the early 70′s. In the late 90′s genes were discovered as contributing to dependencies.
Mind you, there still are consequences for our actions, as it should be. Part of any good treatment plan/program should be facing up to those consequences, and moving on to better choices. A good treatment program, along with goals and expectations, could be used in lieu of, or part of a conviction and sentence.