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Current Obesity Reports

, Volume 5, Issue 2, pp 291–297 | Cite as

Obesity as a Disease: Current Policies and Implications for the Future

  • Scott Kahan
  • Tracy Zvenyach
Obesity Treatment (CM Apovian, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Obesity Treatment

Abstract

The recognition of obesity as a chronic disease is increasing. However, there is variable acknowledgment of it as a disease in health policies across the USA. The objective of this review is to describe how obesity meets the definition of a disease, explain its interpretation in current health policies, and explore implications for obesity in future health policy adoption and development. Perspectives are presented from scientific evidence, clinical practice, and health policy areas including Medicare, Medicaid, the Affordable Care Act, federal government agency guidance, and healthcare quality.

Keywords

Obesity Chronic disease Comorbid condition Treatment Health policy Government Access to healthcare Weight loss 

Notes

Compliance with Ethical Standards

Conflict of Interest

Scott Kahan has received compensation from Vivus, Takeda, Novo Nordisk, and Orexigen for service as a consultant, and has received textbook royalties from Johns Hopkins University Press and Lippincott Williams & Wilkins.

Tracy Zvenyach has received compensation for employment from Novo Nordisk, currently owns stock in Novo Nordisk, and has received tuition assistance from the University of Maryland – Baltimore.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: •Of importance

  1. 1.
    Centers for Medicare and Medicaid Services. CMS manual system pub. 100-03 Medicare national coverage determination. 2004. https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/r23ncd.pdf. Accessed 16 Mar 2016.
  2. 2.
    Jensen MD, Ryan DH, Apovian CM, et al. 2013 AHA/ACC/TOS Guideline for the management of overweight and obesity in adults. Circulation. 2014;129:S102–38.CrossRefPubMedGoogle Scholar
  3. 3.
    Cawley J, Meyerhoefer C, Biener A, et al. Savings in medical expenditures associated with reductions in body mass index among US adults with obesity, by diabetes status. Pharmacoeconomics. 2015;33(7):707–22.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Allison DB, Downey M, Atkinson RL, et al. Obesity as a disease: a white paper on evidence and arguments commissioned by the Council of The Obesity Society. Obesity. 2008;16(6):1161–77.CrossRefPubMedGoogle Scholar
  5. 5.
    Bluher M. Are metabolically healthy obese individuals really healthy? Eur J Endocrinol. 2014;171:R209–19.CrossRefPubMedGoogle Scholar
  6. 6.
    Kramer CK, Zinman B, Retnakaran R. Are metabolically healthy overweight and obesity benign conditions? A systematic review and meta-analysis. Ann Intern Med. 2013;159(11):758–69.CrossRefPubMedGoogle Scholar
  7. 7.
    Hamer M, Bell JA, Sabia S, et al. Stability of metabolically healthy obesity over 8 years. Eur J Endocrinol. 2015;173(5):703–8.CrossRefPubMedGoogle Scholar
  8. 8.
    Arnlov J, Ingelsson E, Sundstrom J, Lind L. Impact of body mass index and the metabolic syndrome on the risk of cardiovascular disease and death in middle-aged men. Circulation. 2010;121(2):230–6.CrossRefPubMedGoogle Scholar
  9. 9.
    Padwal RS, Pajewski NM, Allison DB, Sharma AM. Using the Edmonton obesity staging system to predict mortality in a population-representative cohort of people with overweight and obesity. CMAJ. 2011;183(14):E1059–66.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Garvey WT, Garber AJ, Mechanick JI, et al. American association of clinical endocrinologists and American college of endocrinology position statement on the 2014 advanced framework for a new diagnosis of obesity as a chronic disease. Endocr Pract. 2014;20(9):977–89.CrossRefPubMedGoogle Scholar
  11. 11.
    Aasheim ET, Aylwin SJB, Radhakrishnan ST, et al. Assessment of obesity beyond body mass index to determine benefit of treatment. Clin Obes. 2011;1(2-3):77–84.CrossRefPubMedGoogle Scholar
  12. 12.
    National Institutes of Health. Fact sheet: heart disease. 2013. https://report.nih.gov/nihfactsheets/ViewFactSheet.aspx?csid=96. Accessed 16 Mar 2016.
  13. 13.
    Wadden TA, West DS, Neiberg RH, et al. One year weight losses in the Look AHEAD Study. Obesity. 2009;17(4):713–22.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Sjostrom L, Narbro K, Sjostrom CD. Effects of bariatric surgery on mortality in Swedish Obese Subjects. N Engl J Med. 2007;357:741–52.CrossRefPubMedGoogle Scholar
  15. 15.
    Gortmaker SL, Swinburn BA, Levy D, et al. Changing the future of obesity: Science, policy, and action. Lancet. 2011;378(9793):838–47.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Centers for Medicare and Medicaid Innovation. Evaluation of the health care innovation awards: community resource planning, prevention, and monitoring, annual report 2015. 2016. https://innovation.cms.gov/Files/reports/hcia-ymcadpp-evalrpt.pdf. Accessed 23 Mar 2016.
  17. 17.
    Livingston EH. The incidence of bariatric surgery has plateaued in the U.S. Am J Surg. 2010;200(3):378–85.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Kyle T, et al. Consumers report that health insurance does not often cover obesity treatment, even when wellness programs target BMI. Poster: Obesity Week 2015. In preparation.Google Scholar
  19. 19.
    Internal Revenue Service. 2002. https://www.irs.gov/pub/irs-drop/rr-02-19.pdf. Accessed 14 Mar 2016.
  20. 20.
    Centers for Medicare and Medicaid Services. CMS manual system pub-100-03 Medicare national coverage determinations. 2006. https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R54NCD.pdf. Accessed 15 Mar 2016.
  21. 21.
    Centers for Medicare and Medicaid Services. National coverage determination for intensive behavioral therapy for obesity. 2011. https://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=353&ncdver=1&CoverageSelection=Both&ArticleType=All&PolicyType=Final&s=All&KeyWord=obesity&KeyWordLookUp=Title&KeyWordSearchType=And&bc=gAAAABAAAAAA. Accessed 11 Mar 2016.
  22. 22.
    McTigue KM, Hess R, Ziouras J. Obesity in older adults: a systematic review of the evidence for diagnosis and treatment. Obesity. 2006;14:1485–97.CrossRefPubMedGoogle Scholar
  23. 23.
    U.S. Preventive Services Take Force. Final recommendation statement on obesity in adults: screening and management. 2012. http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/obesity-in-adults-screening-and-management. Accessed 11 Mar 2016.
  24. 24.
    Kahan S, Ferguson C, David S, Divine L. Obesity drug outcome measures: results of a multi-stakeholder critical dialogue. Curr Obes Rep. 2013;2(2):128–33.CrossRefGoogle Scholar
  25. 25.
    Office of Personnel Management. FEHB program carrier letter. 2014. https://www.opm.gov/healthcare-insurance/healthcare/carriers/2014/2014-04.pdf. Accessed 15 Mar 2016.
  26. 26.
    United States Department of Labor. FAQs about Affordable Care Act implementation (part XXIX) and mental health parity implementation. 2015. www.dol.gov/ebsa/faqs/faq-aca29.html. Accessed 16 Mar 2016.
  27. 27.
    American Medical Association House of Delegates. Recognition of obesity as a disease. 2013. http://www.ama-assn.org/ama/pub/news/news/2013/2013-06-18-new-ama-policies-annual-meeting.page. Accessed 24 Mar 2016.
  28. 28.
    ABC News Medical Unit. Doctors Fight Labeling Obesity a Disability. 2009. http://abcnews.go.com/Health/WellnessNews/story?id=7865711&page=1. Accessed 12 Mar 2016.
  29. 29.
    American Medical Association. Is Obesity a Disease? Video presentation. 2007. http://www.bigshouldersdubs.com/clients/ama/obesity02.Htm. Accessed 10 Mar 2016.
  30. 30.
    National Heart Lung and Blood Institute. Evidence report: clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults. 1998. http://www.ncbi.nlm.nih.gov/books/NBK2003/pdf/Bookshelf_NBK2003.pdf. Accessed 6 Mar 2016.
  31. 31.
    National Heart Blood and Lung Institute. Evidence report: managing overweight and obesity in adults. 2013. https://www.nhlbi.nih.gov/sites/www.nhlbi.nih.gov/files/obesity-evidence-review.pdf. Accessed 8 Mar 2016.
  32. 32.
    Wang YC, McPherson K, Marsh T, et al. Health and economic burden of the projected obesity trends in the USA and the UK. Lancet. 2011;378(9793):815–25.CrossRefPubMedGoogle Scholar
  33. 33.
    US Code, Title 42, Chapter 7, Subchapter XIX, 1396r-8: Payment for covered outpatient drugs. 2012. https://www.law.cornell.edu/uscode/text/42/1396r-8. Accessed 10 Mar 2016.
  34. 34.
    United States Department of Health and Human Services. Independent experts confirm that diabetes prevention model supported by the Affordable Care Act saves money and improves health. 2016. http://www.hhs.gov/about/news/2016/03/23/independent-experts-confirm-diabetes-prevention-model-supported-affordable-care-act-saves-money.html. Accessed 23 Mar 2016.
  35. 35.
    National Conference of Insurance Legislators. Resolution in support of efforts to reduce the incidence of obesity and chronic disease. 2015. https://higherlogicdownload.s3.amazonaws.com/OBESITY/004d4f70-37d5-434e-b24d-08a32dfdfcd9/UploadedImages/071915_Final_NCOIL_Obesity_Resolution_.pdf. Accessed 10 Mar 2016.
  36. 36.
    Petrin C, Prakash K, Gallagher C, Kahan S. Medicaid fee-for-service treatment of obesity interventions. 2014. http://www.stopobesityalliance.org/wp-content/themes/stopobesityalliance/pdfs/Medicaid%20FFS%20Treatment%20of%20Obesity%20Interventions%202014.pdf. Accessed 23 March 2016.
  37. 37.
    Kyle TK, Nadglowski J, Stanford FC. Consumers report that health insurance does not often cover obesity treatment, even when wellness programs target BMI. Oral presentation. The Obesity Society Annual Meeting. 2015.Google Scholar
  38. 38.
    Xia Y, Kelton CML, Guo J, et al. Treatment of obesity: pharmacotherapy trends in the United States from 1999 to 2010. Obesity. 2015;23(8):1721–8.CrossRefPubMedGoogle Scholar
  39. 39.
    Talwalkar A, McCarty F. Characteristics of physician office visits for obesity by adults aged 20 and over: United States, 2012. NCHS Data Brief No. 237. 2016.Google Scholar
  40. 40.
    Inge TH, Boyce TW, Lee M, et al. Access to care for adolescents seeking weight loss surgery. Obesity. 2014;22(12):2593–7.PubMedGoogle Scholar
  41. 41.
    Tsai AG, Asch DA, Wadden TA. Insurance coverage for obesity treatment. J Acad Nutr Diet. 2006;106(10):1651–5.Google Scholar
  42. 42.
    Ogden CL, Carroll MD, Fryar CD, Flegal KM. Prevalence of obesity among adults and youth: United States, 2011–2014. NCHS Data Brief No. 219. 2015.Google Scholar
  43. 44.•
    USPSTF. Draft Research Plan for weight loss to prevent obesity-related morbidity and mortality: Interventions, March 2017. http://www.uspreventiveservicestaskforce.org/Page/Document/draft-research-plan/obesity-in-adults-interventions. Accessed 25 Mar 2016. Draft research plan underway to systematically review and offer health guidance on outcomes for obesity pharmacotherapy and behavioral interventions for weight loss and long-term weight maintenance.
  44. 44.
    Institute of Medicine, Committee on Core Metrics for Better Health at Lower Cost. Vital signs: Core metrics for health and health care progress. 2015. http://www.nationalacademies.org/hmd/~/media/Files/Report%20Files/2015/Vital_Signs/VitalSigns_RB.pdf. Accessed 25 Mar 2016.
  45. 46.•
    Burwell, S. Setting value-based payment goals – HHS efforts to improve U.S. health care. http://www.allhealth.org/briefingmaterials/SETTINGVALUE-BASEDPAYMENTGOALS-HHSEFFORTSTOIMPROVE_2E.PDF. Accessed 25 Mar 2016. CMS is leading adoption and development of novel reimbursement models including value-based purchasing, alternative payments, and healthcare quality measurement policies.
  46. 47.•
    United States Department of Health and Human Services. Independent experts confirm that diabetes prevention model supported by the Affordable Care Act saves money and improves health. 2016. http://www.hhs.gov/about/news/2016/03/23/independent-experts-confirm-diabetes-prevention-model-supported-affordable-care-act-saves-money.html. Accessed 23 Mar 2016. Designates Medicare coverage for the Diabetes Prevention Program and sets precedent for the Secretary to use their authority under the Centers for Medicare and Medicaid Innovation to expand coverage policy.
  47. 47.
    Kushner RF, Butsch WS, Kahan S, et al. Obesity coverage on medical licensing examinations in the United States. What is being tested? Oral presentation. The Obesity Society National Meeting. 2015.Google Scholar
  48. 48.
    Dietz WH, Solomon LS, Pronk N, et al. An integrated framework for the prevention and treatment of obesity and its related chronic diseases. Health Aff. 2015;34(9):1456–63.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  1. 1.George Washington University, The School of Medicine and Health SciencesWashingtonUSA
  2. 2.Johns Hopkins Bloomberg School of Public Health, Johns Hopkins UniversityBaltimoreUSA
  3. 3.University of Maryland School of NursingBaltimoreUSA
  4. 4.Georgetown University School of Nursing and Health StudiesWashingtonUSA

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