Medicare beneficiaries will be able to get coverage for preventive obesity counseling, CMS (Centers for Medicare and Medicaid Services) announced today. The CMS says this is part of the widening range of preventive services CMS has been adding to its coverage since the signing of the Affordable Care Act. Covering the costs for preventive obesity counseling complements the Million Hearts initiate, CMS explained in a communiqué.
CMS Administrator Donald M. Berwick, MD., said:
“Obesity is a challenge faced by Americans of all ages, and prevention is crucial for the management and elimination of obesity in our country. It’s important for Medicare patients to enjoy access to appropriate screening and preventive services.”
Approximately one third of Medicare beneficiaries are thought to be obese.
Obesity can raise the risk of developing the following conditions and diseases:
- Abnormal periods
- Coronary heart disease
- Diabetes mellitus type 2
- Gallbladder disease
- High blood cholesterol
- High blood pressure
- High triglyceride levels
- Liver disease
- Metabolic syndrome
- Respiratory problems
- Several cancers
- Sleep apnea and other sleep disorders
- The risk of a cancer being a rapidly progressive one
According to the CDC (Centers for Disease Control and Prevention), the medical care costs of obesity in America in 2008 amounted to $147 billion.
The CMS says that such chronic diseases as diabetes type 2 and cardiovascular diseases affect some racial and ethnic minorities disproportionately. If obesity-related disparities can be addressed beforehand, the chances of significantly reducing obesity rates is much greater, as well as closing the wide health disparities that currently exist among Medicare beneficiaries.
Under this new benefit, eligible patients who receive obesity screening and counseling at primary care centers will be covered.
If the screening shows that the patient is obese, i.e. has a BMI (body mass index) of at least 30, the following would be covered by Medicare:
- Four weekly counseling sessions (one per week)
- One face-to-face counseling session every fortnight for a further five months
- If the patient manages to reduce enough weight (6.6 pounds or 3 kilos in six months), they would be covered for further once-monthly counseling sessions for six months (providing a total of 12 months)
CMS Chief Medical Officer and Director of the Agency’s Office of Clinical Standards and Quality, Patrick Conway, MD, MSc, said:
“This decision is an important step in aligning Medicare’s portfolio of preventive services with evidence and addressing risk factors for disease. We at CMS are carefully and systematically reviewing the best available medical evidence to identify those preventive services that can keep Medicare beneficiaries as healthy as possible for as long as possible.”
There are two ways of working this out – one is Waist-Hip Ratio, and the other is BMI.
BMI (Body Mass Index)
This measures your height and weight. It is less accurate than waist-hip ratio, and many experts believe it will gradually give way to waist-hip ratio.
The flaw in BMI is that it does not measure body fat versus muscle content in the person. A 6ft tall 100 meter Olympic champion may weigh more than a 6ft unfit couch potato – even though the athlete has a small waist and is definitely not overweight, his BMI will show he is fatter than the couch potato. A waist-hip ratio measurement will not make this mistake. The BMI Classification is as follows:
- Underweight – anything below 18.5
- Normal weight – from 18.5 to 24.9
- Overweight – from 25 to 29.9
- Class 1 obesity – from 30 to 34.9
- Class 2 obesity – from 35 to 39.9
- Class 3 obesity – 40+ (also known as morbidly obese)
Measuring your BMI in metric units: The person’s weight in kilos divided by the square of their height. For example, an 80 kilogram person whose height is 1.8 meters has a BMI of 24.69 (1.82 = 3.24. 80 divided by 3.24 = 24.69).
Measuring your BMI in imperial units: The person’s weight in pounds times 703, divided by the square of their height in inches. For example, a 72-inch tall person weighing 190 pounds has a BMI of 25.76 (190 x 703 divded by 5,184 + 25.76).
Three waist circumfurences illustrating examples of ideal, overweight and obese
Waist-Hip Ratio (WHR)
In this case, the waist measurement is divided by the hip measurement. For example, if a female’s waist is 28 inches and her hips are 36, her WHR is 0.77 (28 divided by 36).
Male waist-hip ratios:
- Less than 0.9 – ideal weight. The risk of health problems is generally low.
- 0.9 to 0.99 – overweight. There is a moderate risk of some health problems.
- 1 or more – obese. There is a high risk of health problems.
Female waist-hip ratios:
- Less than 0.8. Ideal.
- 0.8 to 0.89 – overweight.
- 0.9 or more – obese.
Written by Christian Nordqvist