Fat Chance
It may be true that having the government pay for weight-loss treatments would save lives and money. Diabetes, heart disease and other serious chronic illnesses linked to obesity are expensive to treat. Even some cancers might be avoided. Researchers from the Mayo Clinic analyzed the medical records of almost 30,000 older women over 13 years. They reported this month that the women who followed at least six of nine lifestyle recommendations -- most of them related to weight control, such as healthy diet and exercise -- had a 35% lower incidence of cancer than the women who followed one or none.
In the long run, maybe having Medicare cover treatments even for people without obesity-related medical problems would prevent costly surgery and chemotherapy and the suffering they entail. In the short run it looks like a different story. You can see the diet gurus and weight-loss fakers lining up for a share of this fat financial pie, even though Health and Human Services Secretary Tommy G. Thompson isn’t -- yet -- proposing any extra funding.
The potential for a federally funded snake-oil program seems high, despite assertions from Thompson’s office that Medicare would cover only treatments proven by “scientific and medical evidence.”
What does that mean? The only thing the medical field seems certain of so far is that the suggested changes would green-light the burgeoning business of gastric bypass surgery, one of the most expensive and invasive weight-loss procedures. Problem is, despite a raft of weight-loss studies, relatively little is known about how to get people to lose weight and keep it off.
Everyone can come up with a study showing that his or her program works -- at least for a few months. But the real point of paying for weight-loss programs would be to make people healthier. It isn’t even known if weight loss creates healthier people without the changes outlined in the Mayo Clinic study -- more fruits, vegetables and whole grains, regular exercise and less red meat, for a few.
Federal policy has traditionally been more comfortable with conventional medical practice -- surgery and prescription drugs -- than with preventive care. That’s why both government and private insurance companies have been slow to address people who need help losing weight or quitting cigarettes. If it’s not done by an MD or with a pill, no one at the policy level is quite sure how to go about it.
Some cynics have wondered whether the vague Medicare proposal, which was announced last week, is an election-year ploy to be forgotten after November. Give Thompson the benefit of the doubt on that, and give him credit for trying to promote health, not just treat illness. Carrying it out will require similar rethinking. Instead of vague but sweeping coverage, Medicare should start out small. It could cover a few well-accepted, low-priced practices likely to bring long-term change to the largest number of people at least cost to taxpayers. That might mean paying for Weight Watchers memberships, or covering part of the price of regular visits to a family physician or registered dietitian for diet and exercise supervision. Then check for results and expand incrementally.
Otherwise, this nation is headed for one obese boondoggle.
