This guide is a unique tool for health care providers that offers guidance and suggestions on how to initiate conversations with adult patients about weight and health. The tool is designed to help providers build a safe and trusting environment with patients to facilitate open, productive conversations about weight.
STOP Director, Dr. Bill Dietz, recently published an article in Health Affairs. Along with a group of co-authors with expertise in research, clinical care, health policy, and public health, Dr. Dietz offered a new model for addressing the obesity epidemic, one that reaches beyond clinical intervention to include community systems as well. The paper proposes a modern framework, integrated in its approach to address both the prevention and treatment of obesity and its related chronic diseases. Accompanying the article is a figure which illustrates this proposed framework.
Morgan Downey, STOP Alliance Policy Advisor, weighs in on where Obamacare, the Affordable Care Act (ACA) is today as it moves closer to the key date, October 1, 2013. What do you need to know? Individual mandate? State exchanges? Essential health benefits?
We often talk about community-based efforts to prevent and reduce obesity, but we may not realize that these initiatives aimed at the broader public actually have origins within a clinical setting. The Affordable Care Act placed a heavier emphasis on public health and prevention efforts throughout the entire health care system, strengthening the role that hospitals play in community health promotion.
Click here to read more.
View this new on-line guide created that offers practical advice for parents struggling with how to discuss weight and health with their children.
Under the Patient Protection and Affordable Care Act (ACA), the Secretary of Health and Human Services (HHS) is required to establish a minimum standard of coverage, or "essential health benefits" package, that must be included as of 2014 by all qualified health plans offered though Health Insurance Exchanges established under Section 1302 of the ACA as well as through insurers in individual and small group markets. The ACA also sets forth a series of broad benefit classes that the Secretary's definition of essential benefits must include. To help in this effort, the Secretary has asked for assistance from the Institute of Medicine (IOM). The IOM has established a Committee on the Determination of Essential Health Benefits to develop the framework for establishing the essential health benefits package and is expected to issue its report by the end of September 2011.
The STOP Obesity Alliance's Essential Benefits Task Force has developed consensus recommendations to help inform the Secretary and the IOM regarding treatments for obesity and related co-morbidities that should be considered essential health benefits and covered by all non-grandfathered qualified health plans. At the root of these recommendations is the belief that obesity and weight-related interventions should not be treated differently than any other health condition.
In the process of developing a set of principles of coverage for obesity-related services, participating members of the Alliance's Essential Health Benefits Task Force reviewed current federal evidence-based guidelines relating to the recommendation of services to be provided to patients with overweight and obesity by physicians and physician extenders, and how they relate to coverage requirements under the ACA. Based on the evidence, the Task Force has developed a set of overarching principles detailed below, as well as more specific recommendations of types of services that should be covered under each of the 10 categories of essential benefits.
The following are the essential benefit classes and the Task Force’s recommendations for what should be included under the ACA-defined coverage categories. The Task Force recommends that treatment for obesity should not be summarily excluded and that treatments or services that cross between coverage categories should not be excluded or subject to additional cost sharing as compared to other types of treatments or services.
The Task Force believes that at a minimum the recommendations from the following two organizations should be used for the evidence base for obesity and obesity-related chronic disease prevention, treatment, and management.
U.S. Preventive Services Task Force (USPSTF) Recommendations for Obesity Treatment
The Task Force agrees that the USPSTF recommendations with an “A” or “B” rating should be covered as a minimum under the essential health benefits package.
The following is the current USPSTF recommendation of primary and preventive services for adults with obesity:
The USPSTF recommends that clinicians screen all adult patients for obesity and offer intensive counseling and behavioral interventions to promote sustained weight loss for obese adults. Rating: B recommendation2
National Heart, Lung, and Blood Institute (NHLBI) Recommendations for Obesity Treatment
The Task Force believes NHLBI evidence-based recommendations for the treatment of obesity should be considered as essential health benefits.
NHLBI recommends treating obesity based on evidence from randomized controlled trials that show that weight loss not only helps control diseases, but may also reduce the likelihood of developing those diseases. Specifically, the NHLBI recommends the following interventions for weight loss and weight management3:
Combined Therapy, and
Weight Loss Surgery.
The Task Force recommends that no evidence-based treatments for obesity should be excluded from coverage and that such services have cost sharing that is no greater than that which is required by other comparable treatments.
There are often blanket exclusions placed on the coverage of weight-loss treatments. Where there is coverage, often the cost sharing requirements for the intervention are much higher than for comparable interventions to prevent or treat non-obesity related diseases or conditions. For example, studies indicate bariatric surgery produces significant improvements in both the short- and long-term, but despite the benefits of surgical intervention, and the NHLBI recommendations less than two percent of eligible patients undergo bariatric surgery each year in the United States.4
View Dr. Richard H. Carmona’s, 17th U.S. Surgeon General and the Alliance’s Health and Wellness Chairperson, letter of support for the Essential Health Benefits Task Force recommendations here.
1 Needham B, Epel E, Adler N, Kiefe C. Trajectories of Change in Obesity and Symptoms of Depression: The CARDIA Study. American Journal of Public Health. 2010;100(6):1040-1046.
2 U.S. Preventive Services Task Force. Screening for Obesity in Adults. Recommendations and Rationale. November 2003. http://www.uspreventiveservicestaskforce.org/3rduspstf/obesity/obesrr.htm.
3 National Health, Lung, and Blood Institute. http://www.nhlbi.nih.gov/about/org/mission.htm.
4 Brolin R. Bariatic Surgery and Long-term Control of Morbid Obesity. JAMA. 2002—288(22); 2793-2796.