New obesity treatment guideline could improve insurance coverage for weight loss counseling

With all the hoopla over new cholesterol treatment guidelines, very little attention was paid to another recommendation released Tuesday, by the same medical organizations, about how to treat obesity.

The new obesity treatment guideline, released by the American Heart Association and American College of Cardiology, provides a solid roadmap for doctors challenged with helping patients with obesity-related health conditions achieve a healthier weight.

Insurance coverage for weight-related counseling, such as helping patients plan new menus with fewer calories or outline a realistic fitness program, could improve under these guidelines. More importantly, they outline which interventions are the most effective based on clinical trials.

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The guidelines state that during routine physicals, patients should have their height and weight measured to calculate their body mass index . For those patients who are obese, with a BMI of 30 or above (180 pounds or more for a 5-foot-5 person), doctors should discuss treatment options.

Doctors should also consider treating those who are overweight—patients with a BMI between 25 to 30 (150 to 180 pounds for a 5-foot-5 person)—if they have certain heart disease risk factors like type 2 diabetes, hypertension, high cholesterol, or a large waist size. People at a healthy weight, or who are overweight without any health problems, should be advised to keep their weight steady.

Perhaps these obesity treatment recommendations garnered no front-page headlines because the advice isn’t surprising and doesn’t deviate much from what doctors would already do—if they could set aside the time to help patients manage their weight issues.

“It’s not just about body weight, but whether excess body weight is associated with medical conditions,” said Dr. Timothy Church, director of preventive medicine research at Pennington Biomedical Research Center who was not involved in writing the guideline.

Obesity, in and of itself, is now considered a disease that requires treatment, according to the American Medical Association.

While prescription weight-loss drugs and bariatric weight-loss surgeries are endorsed by the American Heart Association and American College of Cardiology as effective treatments in these guidelines, doctors are advised to offer these options only after a patient has already failed to lose and maintain a weight loss of 5 to 10 percent of their body weight by following a “comprehensive lifestyle” program.

What do the guideline authors mean by comprehensive? Patients should come in for meetings with weight loss counselors two to three times a month for at least six months to revamp their fitness and eating routine and work on triggers that cause them to overeat. Programs such as Weight Watchers or the YMCA’s Weight Loss for Life would qualify, as would those offered by weight management clinics housed in teaching hospitals.

“I think this is a good recommendation, because studies have shown that in-person interactions work better than phone or online counseling for weight loss,” Church said. Such treatments are usually more costly, but he predicts that insurance companies will increase their reimbursements as a result of the new guideline. “I think we’re going to see a dramatic change in how we reimburse obesity treatments across the board,” he added.