The Food and Drug Administration's (FDA) approval of highly effective anti-obesity medications is changing the lives of millions of Americans—and changing how we perceive one of our most prevalent chronic diseases.
Forty-two percent of adults in the U.S. live with obesity. This condition often disproportionally affects people of color and those in rural and underserved communities. It is associated with a range of serious medical conditions, including high blood pressure, diabetes, heart disease, stroke, and cancer—not to mention the additional stress the condition places on the body, including the joints, bones, and respiratory system. It can affect a person's mental health and in some cases, the condition can cut one's lifespan by as much as 14 years.
As obesity has become a growing health issue in America over the past few decades, the urgency of ending the outdated prohibition on Medicare coverage of obesity treatments has accelerated. Most notably, in 2013, the American Medical Association, the largest association of physicians in the country, recognized obesity as a disease that requires a variety of interventions and treatment. There is now a consensus in the medical community that obesity is a complex and chronic disease that can be caused by many factors.
This new understanding of obesity means we must change how it is treated, especially when we have new tools to treat it. This starts by expanding access to treatments such as intensive behavioral therapy (IBT), comprehensive nutritional and mental health treatment and new, highly effective, anti-obesity medications. Two out of five U.S. adults are currently obese, and these doctor-prescribed, FDA-approved medications, along with diet and exercise, can help individuals with obesity lose up to 20 percent of their body weight, lowering one's risk for numerous maladies. The return on investing in a healthy America is clear.
When Medicare Part D, also known as the Medicare Prescription Drug Benefit program, was created at the turn of the century, obesity was largely viewed as a cosmetic issue and at that time with no effective prescription treatments available, coverage was explicitly excluded in the new law.
Congress has been considering bipartisan solutions to help address the growing obesity problem for over a decade now, and these new treatments add urgency: Medicare's prohibition means over 1 million people currently taking obesity medications who are about to age into Medicare will lose coverage and access to their currently prescribed treatments. Aging into Medicare shouldn't strip away any senior's access to their prescription medications.
To ensure these medications and holistic treatment plans remain accessible to seniors who age into Medicare, we have introduced a tailored version of the Treat and Reduce Obesity Act (TROA) to specifically protect these new beneficiaries from losing their current access. This bill has momentum: it received strong bipartisan support in the House Ways and Means Committee, and it is our hope that the House will soon advance the bill in a full vote.
In order to have a comprehensive, holistic, treatment approach, we are also working to expand patient access to IBT under Medicare. Intensive behavioral therapy, which encompasses nutritional and exercise counseling, is key to helping obese individuals make lifestyle changes that support weight loss—whether they take medications or not, as medications may be temporary for some. Currently, access to this counseling through Medicare is severely restricted. Our legislation would align this treatment with current clinical guidelines and scientific findings.
Prior to the House Ways and Means Committee vote in June, our efforts to remove the Medicare coverage barriers for all beneficiaries had seen little movement despite enjoying widespread support on both sides of the aisle for over a decade. The amended version of TROA addresses the pressing reality that patients are losing access to treatment as they age into Medicare.
In Washington, D.C., we put a dollar value on the cost of legislation, but not on a healthy human being. While policymakers often focus on what paying for a cure costs today, they frequently fail to acknowledge that not treating these conditions has massive long-term costs. Treating Medicare beneficiaries with obesity would not only save billions we spend to treat obesity-related complications; it will also ensure Americans stay healthy longer so that they can work, pay taxes, and be productive members of our communities. Refusing to cover cures that cost money now, but save money in the long run, is a pound-wise, penny-foolish approach, but it's also too often Washington's approach to health care.
Our goal is to ensure that people currently undergoing treatment for obesity can continue to have coverage for their successful, effective treatment plans. Obesity treatments are most effective long-term, and losing access mid-treatment can have damaging, sometimes devastating, health consequences. The targeted version of TROA will help those who currently have access through their insurance, such as the state employee health plans, the 15 state Medicaid programs that cover obesity medications, federal employee health plans, and all the employer-based plans that offer coverage.
This is an important first step. While there is a lot of work ahead, this legislation has the potential to change the lives of seniors who depend on obesity treatments on their journey to become healthier and reduce further comorbidities and chronic conditions.
Improving access to treatment, both medicinal and counseling, is one vital effort we can make to improve the health and well-being of millions of Americans. That's why, as members of Congress, we remain committed to advocating for people with obesity.
Brad Wenstrup, a Republican, represents Ohio's Second Congressional District in the U.S. House of Representatives. Gwen Moore, a Democrat, represents Wisconsin's Fourth Congressional District in the U.S. House of Representatives.
The views expressed in this article are the writers' own.
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