Treat and Reduce Obesity Act of 2015

(H.R. 2404 / S. 1509)

Brief Summary of Title XVIII of the Social Security Act:
Title XVIII of the Social Security Act, commonly called “Medicare” but
officially designated “Health Insurance for the Aged and Disabled” was Key Takeaways:
enacted in 1965 and established a health insurance program for persons
 Fighting the Obesity
aged 65 years or older as a complement to the retirement, disability, and
Epidemic
survivors insurance benefits authorized under Title II (Klees, Wolfe, &
Curtis, 2009). Now, individuals receiving Social Security or Railroad  28.9% of Marylanders
Retirement disability benefits, with end-stage renal disease, or with Lou are obese
Gehrig’s disease are also eligible for Medicare benefits (Klees et al.,  29.4% of obese
2009). individuals are ≥ 65
years and 34.4% are
The Centers for Medicare and Medicaid Services (CMS) within the U.S. aged 45-64 years
Department of Health and Human Services (DHHS) administers the  Chronic disease is the
Medicare program, which has parts: Part A – Hospital Insurance Benefits leading healthcare cost
for the Aged and Disabled, Part B – Supplementary Medical Insurance in MD.
Benefits for the Aged and Disabled, Part C – Medicare + Choice Program,  1/3 of MD Medicare
a private health plan, and Part D – Voluntary Prescription Drug Benefit recipients have CVD or
Program (Klees et al., 2009). diabetes
 Act expands IBT coverage
The Problem: Maryland’s Obesity Epidemic for obese Medicare
recipients to include
Obesity is a significant risk factor for many chronic diseases, including
diabetes, cardiovascular disease, hypertension, several types of cancer, other healthcare
and non-alcoholic fatty liver disease and a major factor in healthcare professionals
costs (National Institute of Diabetes and Digestive and Kidney Diseases,  Cost Effective Solution
2012). In the U.S., 4 of the top 10 leading causes of death (heart disease,  23% of Medicare costs is
cancer, stroke, and diabetes) are associated to obesity and associated with obesity
approximately 1 in 5 deaths in the U.S. is associated to obesity (Laidman,  IBT by a RD is up to
2013). In 2006, per capita spending was estimated to be 42% greater for 15% cheaper than other
obese individuals than their healthy-weight counterparts, and in 2012, health care providers
obesity-related expenditures were estimated to account for 20.6%  Clinically Effective
($209.7 billion) of national healthcare expenditures in the U.S. (Cawley &  USPSTF found IBT is an
Meyerhoefer, 2012; Finkelstein, Trogdon, Cohen, & Dietz, 2009). effective weight loss
Furthermore, it is estimated that it costs 7 times more to treat an strategy & reduces CVD
individual with comorbidities than an individual with 1 chronic disease and diabetes risk
(Udow-Phillips, Kofke-Egger, & Ehrlich, 2010).  IOM declares IBT by a
RD to be more effective
Of Maryland’s nearly 6 million residents, two-thirds (65.4%) are
than a PCP
overweight, with 28.9% being obese, and of those individuals, 23% have
 IBT by a RD can result
diabetes mellitus, 45% have hypertension, 47% have
in sustained 10%
hypercholesterolemia (Centers for Disease Control and Prevention [CDC],
weight loss

1
2012; Maryland Department of Health and Mental Hygiene, n.d.; Trust for America's Health & Robert
Wood Johnson Foundation, 2016). The majority (34.4%) of Maryland’s obese individuals are aged 45-64
years, followed by 29.4% being aged 26-44 years and 29.4% being 65 years or older (Trust for America's
Health & Robert Wood Johnson Foundation, 2016). In Maryland, the largest source of healthcare
expenditures is chronic diseases, costing an estimated $5.2 billion in direct expenditures in 2003
(Maryland Department of Health and Mental Hygiene, n.d.).

Medicare expenditures were $9.7 billion in 2011 and it is estimated that 23% of Medicare expenditures
are attributable to obesity (CMS, n.d.; Trogdon, Finkelstein, Feagan, & Cohen, 2012). In 2011,
approximately 858,000 Marylanders were enrolled in Medicare, with 127,000 being enrolled in both
Medicare and Medicaid, and 33 and 32% of Medicare beneficiaries and 46 and 39% of Medicare-
Medicaid beneficiaries suffering from diabetes mellitus and cardiovascular disease, respectively (Centers
for Medicare and Medicaid Services [CMS], n.d.).

The Solution: Treat and Reduce Obesity Act

The Treat and Reduce Obesity Act of 2015 (H.R. 2404/S. 1509) was a bipartisan bill that would amend
Title XVIII of the Social Security Act to expand coverage of intensive behavioral therapy (IBT) for obesity
(Congress.gov, n.d.). Currently, IBT is approved for Medicare beneficiaries who have a body mass index
≥ 30 kg/m2 under Part A or Part B when it is implemented by primary care physicians or primary care
practitioners (CMS, 2011). The Treat and Reduce Obesity Act would expand Medicare coverage to allow
IBT to be dispensed by other qualified healthcare professionals, such as non-primary care physicians,
registered dietitians, nutrition professionals, physician assistants, nurse practitioners, clinical
psychologists, clinical nurse specialists, and community and evidence-based DHHS-approved lifestyle
counseling programs and it would authorize coverage of weight loss medications, under Part D, for
overweight beneficiaries who have at least one related comorbidity (Congress.gov, n.d.).

This bill would be a cost-effective and clinically effective solution to obesity. The Institute of Medicine’s
Committee on Nutrition Services for Medicare Beneficiaries (2000) “rates dietary counseling performed
by a trained educator such as a dietitian as more effective than by a primary care clinician.”
Furthermore, the U.S. Preventative Services Task Force found that IBT is an effective weight loss strategy
for obese individuals and reduces the risk of developing CVD and diabetes (Academy of Nutrition and
Dietetics [AND], n.d.). Six to 12 months of IBT by a registered dietitian has shown to result in a 10%
sustained weight loss and IBT by registered dietitians is up to 15% cheaper than IBT by other healthcare
professionals (AND, n.d.).

Take Action – Support the Treat and Reduce Obesity Act

Unfortunately, this bill was not enacted by the 114th Congress, but a new version of this bill is expected
to be introduced this year by Representatives Erik Paulsen (R-MN) and Ron Kind (D-WI) (Obesity
Medicine Association, n.d.).

Take the cost-effective stand to combat obesity and its economic toll for the physical and fiscal health of
your state and country and support this bill!

Prepared by Amanda J. Tome, BS-NDTR as a graduate assignment

NTD 625, West Chester University 2
March 6, 2017
References:
Academy of Nutrition and Dietetics. (n.d.). The Treat and Reduce Obesity Act. Retrieved March 5, 2017 from
http://www.appleadayllc.com/docs/Federal%20Policy/2015%20Treat%20and%20Reduce%20Obesity%20act%20leav
e%20behind.pdf
Cawley, J., & Meyerhoefer, C. (2012). The medical care costs of obesity: an instrumental variables approach. Journal of
Health Economics, 31(1), 219-230. doi:10.1016/j.jhealeco.2011.10.003
Centers for Disease Control and Prevention. (2012). Maryland state nutrition, physical activity, and obesity profile. Retrieved
February 8, 2017 from https://www.cdc.gov/obesity/stateprograms/fundedstates/pdf/maryland-state-profile.pdf
Centers for Medicare and Medicaid Services. (2011). Decision memo for intensive behavioral therapy for obesity (CAG-
00423N). Retrieved March 5, 2017 from https://www.cms.gov/medicare-coverage-database/details/nca-decision-
memo.aspx?&NcaName=Intensive%20Behavioral%20Therapy%20for%20Obesity&bc=ACAAAAAAIAAA&NCAI
d=253
Centers for Medicare and Medicaid Services. (n.d.). Maryland Medicare-Medicaid enrollee information, 2011. Retrieved
March 3, 2017 from https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-
Coordination/Medicare-Medicaid-Coordination-Office/Downloads/2011StateProfilesMD.pdf
Congress.gov. (n.d.). H.R.2404 - Treat and Reduce Obesity Act of 2015. Retrieved March 3, 2017 from
https://www.congress.gov/bill/114th-congress/house-bill/2404
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and service-specific estimates. Health Affairs, 28(5), w822-w831. doi:10.1377/hlthaff.28.5.w822
Institute of Medicine Committee on Nutrition Services for Medicare Beneficiaries. (2000). The Role of Nutrition in
Maintaining Health in the Nation’s Elderly: Evaluating Coverage of Nutrition Services for the Medicare Population.
Washington, DC. Retrieved March 5, 2017 from https://www.nap.edu/catalog/9741/the-role-of-nutrition-in-
maintaining-health-in-the-nations-elderly
Nutrition Services for the Medicare Population.” Washington, DC: Food and Nutrition Board, Institute of Medicine; January 1,
2000 (published) at 2, 267.
Klees, B. S., Wolfe, C. J., & Curtis, C. A. (2009). Brief summaries of Medicare & Medicaid: Title XVIII and Title XIX of the
Social Security Act. Retrieved March 5, 2017 from https://www.cms.gov/Research-Statistics-Data-and-
Systems/Statistics-Trends-and-
Reports/MedicareProgramRatesStats/downloads/MedicareMedicaidSummaries2009.pdf
Laidman, J. (2013, August 15). Obesity's toll: 1 in 5 deaths linked to excess weight. Medscape Medical News. Retrieved March
5, 2017 from http://www.medscape.com/viewarticle/809516
Maryland Department of Health and Mental Hygiene. (n.d.). Obesity. Retrieved March 3, 2017 from
http://phpa.dhmh.maryland.gov/ccdpc/healthy-lifestyles/Pages/obesity.aspx
Maryland State. (2017). Maryland & the federal government: United States House of Representatives. In Maryland Manual
On-Line. Retrieved March 3, 2017 from http://msa.maryland.gov/msa/mdmanual/39fed/06ushse/html/msa02793.html
Obesity Medicine Association. (n.d.). OMA member Robert Huster, MD, FACOG, visits Capitol Hill. Retrieved March 3,
2017 from https://obesitymedicine.org/2017-treat-and-reduce-obesity-act/
Trogdon, J. G., Finkelstein, E. A., Feagan, C. W., & Cohen, J. W. (2012). State- and payer-specific estimates of annual medical
expenditures attributable to obesity. Obesity, 20(1), 214-220. doi:10.1038/oby.2011.169
Trust for America's Health & Robert Wood Johnson Foundation. (2016, September). The state of obesity 2016. Washington,
D.C. Retrieved March 3, 2017 from http://stateofobesity.org/files/stateofobesity2016.pdf
Udow-Phillips, M., Kofke-Egger, H., & Ehrlich, E. (2010, August 3). Health care cost drivers: Chronic disease, comorbidity,
and health risk factors in the U.S. and Michigan. Center for Healthcare Research & Transformation. Retrieved March
6, 2017 from http://www.chrt.org/publication/health-care-cost-drivers-chronic-disease-comorbidity-health-risk-
factors-u-s-michigan/

Prepared by Amanda J. Tome, BS-NDTR as a graduate assignment

NTD 625, West Chester University 3
March 6, 2017