Under Healthcare Law, Overweight Americans May Receive Counseling

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**Frazzled**

http://www.latimes.com/news/nationworld/nation/la-sci-obesity-screening-20120622,0,2815818.story

What if the fatties don't want "intensive counseling?" Whats the next step? Revocation of Insurance Benefits? Gulag, er mandatory weight loss recovery center relocation?

Obese adults should get counseling, federal task force says
Under the healthcare law, insurance companies would be required to cover the panel's recommended weight-loss treatments. The Supreme Court is expected to rule on the law this week.

A federal health advisory panel recommends that all obese adults receive intensive counseling in an effort to rein in an American health crisis. (Jeff J Mitchell / Getty Images / June 25, 2012)
June 25, 2012, 8:23 p.m.
In a move that could significantly expand insurance coverage of weight-loss treatments, a federal health advisory panel on Monday recommended that all obese adults receive intensive counseling in an effort to rein in a growing health crisis in America.

The U.S. Preventive Services Task Force urged doctors to identify patients with a body mass index of 30 or more — currently 1 in 3 Americans — and either provide counseling themselves or refer the patient to a program designed to promote weight loss and improve health prospects.

Under the current healthcare law, Medicare and most private insurers would be required to cover the entire cost of weight-loss services that meet or exceed the task force's standards.

That could all change Thursday, when the U.S. Supreme Courtis expected to rule on the constitutionality of President Obama's healthcare law, which requires adoption of certain recommendations from the task force, such as this one on obesity.

Few private health insurers now reimburse physicians for weight-loss counseling or pay for programs that patients seek out on their own. A growing number, in fact, charge obese patients more for coverage — a policy that some public health officials have denounced as punitive and ineffective.

The task force concluded after a review of the medical literature that the most successful programs in improving patients' health were "intensive, multicomponent behavioral interventions." They involve 12 to 26 counseling sessions a year with a physician or community-based program, the panel said.

Successful programs set weight-loss goals, improve knowledge about nutrition, teach patients how to track their eating and set limits, identify barriers to change (such as a scarcity of healthful food choices near home) and strategize on ways to maintain lifestyle changes, the panel found.

In some cases, programs include exercise sessions as well.

The recommendation, published online in the Annals of Internal Medicine, does not apply to the roughly one-third of Americans who are considered overweight, those with a BMI from 25 to 29.9.

It follows a November decision by Medicare to reimburse physicians for providing "intensive weight counseling" to the roughly 14 million obese Americans insured by the government program.

The new guidelines were met with cautious support by many physicians on the front lines of the nation's struggle against excess fat.

Dr. Jack Der-Sarkissian, a family medicine specialist at Kaiser Permanente's Los Angeles Medical Center, called the guidelines a "long-overdue" prod to physicians to help their patients control weight gain, which raises the risk for diabetes, heart disease and other health threats.

He cited a recent study that found that more than half of all obese patients had never been told by their physician that they needed to lose weight. "That's just not fair to the patient," said Der-Sarkissian, who leads Kaiser's adult weight management efforts in Southern California.

"You have to diagnose the patient and have the discussion, even if the patient doesn't really want to hear it," he said.

But Jeffrey Levi, executive director of the nonpartisan think tank Trust for America's Health, said the recommendations would put physicians in a difficult position: Few have the time or resources to provide obese patients with intensive counseling, he said.

And since programs meeting the standards set by the task force remain scarce, most doctors won't know where to send their obese patients.

"The question is whether the services will develop fast enough to meet the potential demand," Levi said.

Susan Pisano, a spokeswoman for the trade group America's Health Insurance Plans, said it was unclear how the report would affect the industry and patients. But, she said, "there's a lot being done" already by health insurers to help their enrollees lose weight.

Obesity and obesity-related diseases are already responsible for an estimated $147 billion in annual healthcare spending. Widespread adoption of the panel's recommendation would increase that spending, at least initially.

The panel acknowledged that one problem with its recommendation was that no studies have shown such intensive programs provide long-term health benefits.

There appear to be short-term ones. Two studies cited by the panel found that patients who received intensive counseling were 30% to 50% less likely to have Type 2 diabetes two to three years later than those who received lighter counseling, drug therapy or both.

But the counseling subjects' cholesterol numbers barely budged, and changes in blood pressure and waist circumference were, on average, small.

A pilot program considered a model by the task force is now being launched in 21 cities by the federal Centers for Disease Control and Prevention.

It is based on a clinical trial, the Diabetes Prevention Program, that encouraged modest improvements in food choices and at least 150 minutes of weekly exercise for participants, who were at high risk for developing diabetes.

The subjects, who typically met weekly for six months and monthly for the second half of the year, lost between 5% and 7% of their body weight and reduced their diabetes risk by 58%.

**Archaeo**

I would love to sit in if my Korean war vet - retired military father was 'required' to go to one of these sessions. That 80 year old can voice his 'opinion' with the best of them.

**Frazzled**

Archaeo wrote:I would love to sit in if my Korean war vet - retired military father was 'required' to go to one of these sessions. That 80 year old can voice his 'opinion' with the best of them.

Yea Daddy Frazzled was not quiet (well he was as he partially lost his voice in the Corps). But he could "exporess and opinion" with the best of them.

**Jihadin**

Mine won't actually "voice"....that universal sign langauge he occasionaly does works to

**Vulcan**

They're welcome to come bring me in for counceling. And my primary point will be that for the cost of the counceling, I could instead be sent to a doctor (I haven't been able to afford one for years) and find out where my problems REALLY are.

That ought to shut them up posthaste...

**pgmason**

Vulcan wrote: I could instead be sent to a doctor (I haven't been able to afford one for years)

Statements like this just blow my mind! The idea of people not being able to afford what we in Europe regard as a fundamental human right (medical care) in the richest country in the world is just so alien.

**Shadowseer_Kim**

No idea where you live exactly Vulcan, but seeing a primary care physician for a checkup/evaluation whatnot usually runs between $70-$200 for an appointment. Variious clinics will be on the low end cost wise, a private care doctor will be in the higher end.

For where I live the average is about $150. For a once a year checkup/physical. That doesn't break the bank. I could use a clinic for less, but I wouldn't be seeing the same doctor every year.

Can you not put together 100 or some odd dollars in the course of a year? If it really that is important.

**azazel the cat**

Shadowseer_Kim wrote:No idea where you live exactly Vulcan, but seeing a primary care physician for a checkup/evaluation whatnot usually runs between $70-$200 for an appointment. Variious clinics will be on the low end cost wise, a private care doctor will be in the higher end.

For where I live the average is about $150. For a once a year checkup/physical. That doesn't break the bank. I could use a clinic for less, but I wouldn't be seeing the same doctor every year.

Can you not put together 100 or some odd dollars in the course of a year? If it really that is important.

$70-200 to see a doctor? That's fethed up. You have to be able to see how messed up that is.

I am always baffled whenever I see reports about how anyone, ever, could not want universal health care. I mean, beyond abstract rhetoric, is there a logical reason? It can't be the cost, considering the US income tax brakcets are not very different than the ones in Canada (for everyone except the extremely wealthy, that is. There, we diverge greatly).

**Frazzled**

You act like medical care is free azazel. Its not.

**Shadowseer_Kim**

azazel - Yes thats "fethed up" as you say. A doctors visit would be half this price if doctors were made to compete with each other for patients in the free market, and we got rid of most "health insurance" which by my estimates is a huge scam and only drives up the cost of care.

**CT GAMER**

Frazzled wrote:You act like medical care is free azazel. Its not.

But yet if anyone even hints at the need for/benefits of socialized medicine or national healthcare people start whispering "commie" and putting tinfoil hats on...

**Platuan4th**

Shadowseer_Kim wrote:No idea where you live exactly Vulcan, but seeing a primary care physician for a checkup/evaluation whatnot usually runs between $70-$200 for an appointment.

You need to find a new insurance provider, your co-pay SUCKS.

I, however, can't complain. I get free healthcare in America(although if Obama had his way, that wouldn't be true).

**Kovnik Obama**

azazel the cat wrote:
Shadowseer_Kim wrote:No idea where you live exactly Vulcan, but seeing a primary care physician for a checkup/evaluation whatnot usually runs between $70-$200 for an appointment. Variious clinics will be on the low end cost wise, a private care doctor will be in the higher end.

For where I live the average is about $150. For a once a year checkup/physical. That doesn't break the bank. I could use a clinic for less, but I wouldn't be seeing the same doctor every year.

Can you not put together 100 or some odd dollars in the course of a year? If it really that is important.

$70-200 to see a doctor? That's fethed up. You have to be able to see how messed up that is.

I am always baffled whenever I see reports about how anyone, ever, could not want universal health care. I mean, beyond abstract rhetoric, is there a logical reason? It can't be the cost, considering the US income tax brakcets are not very different than the ones in Canada (for everyone except the extremely wealthy, that is. There, we diverge greatly).

With you on this one. Had to pay my visit to a clinic in Alberta when I first moved there, 70$ to get a prescription really hurts.

Universal Healthcare is golden. Paying 44$ a month as a direct deduction on my paycheck beats having to pay 7k the day I catch something which isn't covered.

Gotta ask, do you have to pay a premium on Health Insurance requests?

**Palindrome**

Frazzled wrote:You act like medical care is free azazel. Its not.

Yet the US healthcare system costs approximately double what the NHS costs per patient while being no better and actually performing worse on some criteria (aside from giving patchy treatment to people who simply can't afford it).

Fat people costs far more than thin people and they have a much reduced life expectance and a poorer quality of life. I fail to see how attempting to make people more healthy is a bad thing?

**Jihadin**

2012 Apocalypse around the corner...first to starve is the thin people

**Palindrome**

Jihadin wrote:2012 Apocalypse around the corner...first to starve is the thin people

We will just eat the fatties.

**mattyrm**

Just tax fatties is a better idea. Money talks.

Make them pay for two plane seats too. Why the feth do I only get the same baggage allowance when they weigh 120lbs more than I do?!

**Platuan4th**

Palindrome wrote:
Jihadin wrote:2012 Apocalypse around the corner...first to starve is the thin people

We will just eat the fatties.

Brings a whole new meaning to "Run, fatboy, run!"

**Coolyo294**

Palindrome wrote:
Jihadin wrote:2012 Apocalypse around the corner...first to starve is the thin people

We will just eat the fatties.

Zombieland survival rule #1: Cardio.

**deathholydeath**

Jihadin wrote:2012 Apocalypse around the corner...first to starve is the thin people

Nah. We're just gonna eat the fatties. Yum yum.

**Kovnik Obama**

Jihadin wrote:2012 Apocalypse around the corner...first to starve is the thin people

That's an hilarious misconception. Fat people will suffer from hunger far quicker than thin people. And won't get as much an advantage from every little bit of food they can scrap.

**Frazzled**

CT GAMER wrote:
Frazzled wrote:You act like medical care is free azazel. Its not.

But yet if anyone even hints at the need for/benefits of socialized medicine or national healthcare people start whispering "commie" and putting tinfoil hats on...

Socialized medicine doesn't get risd of the cost.

Automatically Appended Next Post:

Palindrome wrote:
Frazzled wrote:You act like medical care is free azazel. Its not.

Yet the US healthcare system costs approximately double what the NHS costs per patient while being no better and actually performing worse on some criteria (aside from giving patchy treatment to people who simply can't afford it).

Fat people costs far more than thin people and they have a much reduced life expectance and a poorer quality of life. I fail to see how attempting to make people more healthy is a bad thing?

Its the "making" part thats the problem.

Automatically Appended Next Post:

Palindrome wrote:
Jihadin wrote:2012 Apocalypse around the corner...first to starve is the thin people

We will just eat the fatties.

Zombieland rule #1: Cardio.

**Palindrome**

Frazzled wrote:
CT GAMER wrote:
Frazzled wrote:You act like medical care is free azazel. Its not.

But yet if anyone even hints at the need for/benefits of socialized medicine or national healthcare people start whispering "commie" and putting tinfoil hats on...

Socialized medicine doesn't get risd of the cost.

No, but it costs less.

**Vulcan**

America has a common misconception that we do not have socialized health care. We do, it's just done in the stupidest possible way.

What we have is a law that requires hospitals to treat people who come to the emergency room, regardless of ability to pay. Granted, the hospital will ruin your credit for 7 years if you don't pay, but they can't turn you away for being broke.

What then happens is, the people who cannot afford regular health care go to the emergency room with their entirely-preventable aliments. The emergency room. The second most expensive part of the health care system (only behind Intensive Care, IIRC). And because their problems have gone on so long before they get serious enough to require the hospital trip, they often wind up in Intensive Care afterwards.

Now, I'm sure you are all aware that the hospitals cannot - literally cannot - eat that expense and remain in business. Even not-for-profit hospitals (what few of those there are) have to pay for the doctors, nurses, morgage, supplies, etc. etc. etc. So... how do they make that cost up?

They charge the paying customers EXTRA. That's right, you pay extra to the hospitals because they are required BY LAW to treat poor people. In short, Socialized Health Care.

And just because you haven't been to a hospital doesn't mean you aren't paying for it. Potential hospital costs are a big factor in how much you pay for your Health Insurance. (Another big factor is the health insurance company's need to post ever-increasing profits if it doesn't want its stock values to drop, a subject that is of GREAT interest to the executives running the company, whose stock options are often more valuable than their estwhile salary... but that's another rant...)

If you think we don't have Socialized Health Care in America, you're seriously just decieving yourself.

**azazel the cat**

Kovnik Obama wrote:Universal Healthcare is golden. Paying 44$ a month as a direct deduction on my paycheck beats having to pay 7k the day I catch something which isn't covered.

Gotta ask, do you have to pay a premium on Health Insurance requests?

Are you asking me? In BC, I think we have the highest monthly premiums. I think I pay $48 per month.

Frazzled wrote:Socialized medicine doesn't get risd of the cost.

Its the "making" part thats the problem.

See, that's what I meant when I said "abstract rhetoric". The principle is no different than it is for innoculations against Polio: everyone gets them, for the greater good of everyone. The same idea works with universal health care: everyone pays into the system just a little bit, and then everyone gets universal health care. This is far better than the sacrificial lottery that is currently being run in the US, wherein whoever gets sick either has millions to spend, or else loses everything they own to pay for it, or dies.

And as for the cost: in Canada, we have universal health care, 1/10 your population, and 1/24 your national debt. So obviously it's very possible to implement the system, economically speaking.

EDIT: The only reason that you don't have UHC in the US is because of the propaganda campaign that was started in the 1970s by Richard Nixon and the insurance company lobbyists.

**Vulcan**

Oh, one more point to make...

Allowing EVERYONE to be able to go to the doctor means those preventable aliments (say, high blood pressure) can actually be treated by a doctor in an office visit. This is FAR cheaper than the thousands - if not TENS of thousands - of dollars spent when that high blood pressure results in a heart attack or stroke.

**Kovnik Obama**

azazel the cat wrote:
Kovnik Obama wrote:Universal Healthcare is golden. Paying 44$ a month as a direct deduction on my paycheck beats having to pay 7k the day I catch something which isn't covered.

Gotta ask, do you have to pay a premium on Health Insurance requests?

Are you asking me? In BC, I think we have the highest monthly premiums. I think I pay $48 per month.

Nah, I'm asking any american. And by premium, I mean that amount that needs to be paid in order to get the Insurance to cover a claim (like in a car crash, I'd have to pay what, about 600$ in order to get the amount I'm insured for).

**Platuan4th**

Kovnik Obama wrote:
azazel the cat wrote:
Kovnik Obama wrote:Universal Healthcare is golden. Paying 44$ a month as a direct deduction on my paycheck beats having to pay 7k the day I catch something which isn't covered.

Gotta ask, do you have to pay a premium on Health Insurance requests?

Are you asking me? In BC, I think we have the highest monthly premiums. I think I pay $48 per month.

Nah, I'm asking any american. And by premium, I mean that amount that needs to be paid in order to get the Insurance to cover a claim (like in a car crash, I'd have to pay what, about 600$ in order to get the amount I'm insured for).

We tend to pay what's called a copay. Most are charged depending on what health service you're accessing.

http://en.wikipedia.org/wiki/Copayment

**Kovnik Obama**

Platuan4th wrote:
Kovnik Obama wrote:
azazel the cat wrote:
Kovnik Obama wrote:Universal Healthcare is golden. Paying 44$ a month as a direct deduction on my paycheck beats having to pay 7k the day I catch something which isn't covered.

Gotta ask, do you have to pay a premium on Health Insurance requests?

Are you asking me? In BC, I think we have the highest monthly premiums. I think I pay $48 per month.

Nah, I'm asking any american. And by premium, I mean that amount that needs to be paid in order to get the Insurance to cover a claim (like in a car crash, I'd have to pay what, about 600$ in order to get the amount I'm insured for).

We tend to pay what's called a copay. Most are charged depending on what health service you're accessing.

http://en.wikipedia.org/wiki/Copayment

To me this seems to completly defeat the purpose of a Health Insurance.

I mean, you have a choice, being uninsured and have $10 000 in a account somewhere safe, or pay monthly insurance fees. So if I chose to pay monthly fees, that'd be because I don't want to bother with saving $$$ every paycheck because I might fall down the stairs someday. But, even if I'm insured, I still have to worry about saving $$$ to pay to get that eventual amount, just a lot less...

That sounds like a crappy system to me...

**Jihadin**

Our healthcare...your healthcare..people are brought up under both system so each is use to their own. Some points are being made "at the moment" healthcare service. Depending on the injury/sickness/whateverthefukkailsyou paying back or free healthcare takes a back seat when your down and out. Because your main concern going to be taking up by...Do I have enough sickleave? How much do I have saved up to cover bills? How far can I stretch whatever additional incoming finance to break even till I can get back to work. How much ramien and hotdogs can I eat and can I really do it back to back if need be.