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Medicare to cover obesity { July 16 2004 }

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July 16, 2004
Deletion Opens Medicare to Coverage for Obesity

WASHINGTON, July 15 - A small change in the language of a government manual has opened the door for obesity treatments to be covered under Medicare, the Bush administration said on Thursday.

A new policy handed down by the Department of Health and Human Services removes the phrase "obesity itself cannot be considered an illness" from the Medicare Coverage Issues Manual, allowing scientists, clinicians and companies to submit proposals recommending that certain treatments be covered. The change was first reported on Thursday in The Wall Street Journal.

Eighteen percent of the Medicare population is obese, according to the American Obesity Association, a nonprofit advocacy group. From 1991 to 1998, the prevalence of obesity among people ages 60 to 69 increased 45 percent, the association said.

"With this new policy, Medicare will be able to review scientific evidence in order to determine which interventions improve health outcomes for seniors and disabled Americans who are obese," Tommy G. Thompson , the secretary of Health and Human Services, said in a prepared statement.

Those interventions could come in the form of surgical procedures, dietary counseling or cognitive behavioral therapies. (Drug treatments for obesity were ruled out for coverage under Medicare with the passage of the Medicare Modernization Act of 2003.)

"From an insurance point of view, you would look at covering things that are more expensive," said Morgan Downey, the executive director of the American Obesity Association.

The most expensive treatment for obesity is bariatric surgery, a $30,000 procedure that involves closing off much of the stomach and shortening the small intestine to make less room for food, creating the sensation of fullness more easily for an obese patient.

Medicare does cover bariatric surgery but not for obesity itself. Hypertension, stroke and congestive heart failure, which often result from obesity, can justify treatments covered under Medicare.

"We think going to the root of the medical problem is better than just treating the symptoms," Mr. Downey said.

The new policy does not affect the existing Medicare coverage for treatments of diseases that result in or are made worse by obesity, federal officials said. But consumers, doctors, psychologists and sponsors of diet and nutrition programs are expected to file requests for coverage of a wide range of treatments.

"The question is not whether obesity is a disease or a risk factor," said Dr. Mark B. McClellan, administrator of the federal centers for Medicare and Medicaid Services. "What matters is whether there's scientific evidence that an obesity-related medical treatment improves health."

Medicare's previous policy said that payments "may not be made for treatment of obesity alone, since this treatment is not reasonable and necessary for the diagnosis or treatment of an illness or injury."

Now, as providers of therapies and treatments apply for Medicare coverage, officials will review the scientific evidence, using procedures established in 1999 and modified by the new Medicare law.

In making coverage decisions, Medicare officials said, they will generally require data from clinical trials showing that obesity-related treatments will improve the health of beneficiaries.

In the last year, Bush administration officials have described obesity as a growing public health problem. Mr. Thompson often exhorts Americans to exercise more, and he has tried to persuade fast-food executives to serve more healthy meals. But the administration has generally opposed legislation that would ban candy, soft drinks and unhealthy food from school vending machines.

Dr. McClellan said the new policy would put the focus on public health.

"Medical science will now determine whether we provide coverage for the treatments that reduce complications and improve quality of life for the millions of Medicare beneficiaries who are obese," he said.

Robert Pear contributed reporting for this article.

Copyright 2004 The New York Times Company

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