Lots Of Seniors Are Overweight, But Few Use Free Counseling For It
Anne Roberson walks a quarter-mile down the road each day to her mailbox in the farming town of Exeter, deep in California's Central Valley. Her daily walk and housekeeping chores are her only exercise, and her weight has remained stubbornly over 200 pounds for some time now. Roberson is 68 years old, and she says it gets harder to lose weight as you get older: "You get to a certain point in your life and you say, 'What's the use?' "
For older adults, being mildly overweight causes little harm, physicians say. But too much weight is especially hazardous for an aging body. Obesity increases inflammation, exacerbates bone and muscle loss and significantly raises the risk of heart disease, stroke and diabetes.
To help the nation's 13 million obese seniors, the Affordable Care Act included a new Medicare benefit offering face-to-face weight loss counseling in primary care doctors' offices. It is free for patients, with no copay. But while Medicare now pays doctors to counsel their obese patients, only 50,000 people participated in 2013, the latest year for which data is available.
"We think it's the perfect storm of several factors," says Dr. Scott Kahan, an obesity medicine specialist at George Washington University. Kahan says obese patients and doctors aren't aware of the benefit, and doctors who want to intervene are often reluctant to do so.
"It used to be thought that older patients don't respond to treatment for obesity as well as younger patients," Kahan says. "People assume that they couldn't exercise as much or for whatever reason they couldn't stick to diets as well. But we've disproven that."
Indeed, one study found 2 out of 3 older patients lost 5 percent or more of their initial weight and kept it off for two years.
Weight loss specialists say the reason why few seniors are taking advantage of the new benefit is the federal government's decision to limit counseling to primary care offices.
"The problem with using only primary care providers," says Bonnie Modugno, a registered dietician in Santa Monica, Calif., "is that they completely ruled out direct reimbursement for the population of providers who are uniquely qualified and experienced working with weight management. I think that was a big mistake."
Modugno says she is sympathetic to the government's concerns about widespread fraud — that just about everyone in the weight loss and fitness world wanted to be able to bill Medicare for obesity counseling. But she says doctors should be allowed to refer their patients to registered dieticians like her. "Unless we change the nature of how this occurs, how the counseling occurs, I don't see it being available to people in a meaningful way," says Modugno.
The benefit also can't be used by endocrinologists, who might be managing a person's diabetes, or by cardiologists, who monitor patients with heart disease. Both conditions can be caused or made worse by excess weight.
As for Anne Roberson, she says the extra weight she has long carried around on her petite frame has begun taking a toll on her joints, her sleep and her mood. On a recent morning, Roberson listened politely to Dr. Mylene Middleton Rucker, her longtime physician, during her first Medicare weight loss counseling session. Rucker suggested she eat more vegetables and less meat and encouraged her to join a local exercise class.
Rucker, who is obese herself, says she doesn't expect her older patients to lose a lot of weight. "I think you'll see weight loss of 10 to 20 pounds, but whether you're going to see people lose 50 to 100 pounds as they're older, I doubt it," says Rucker.
Still, even with small amounts of weight loss, Rucker expects to see a decrease in the complications of chronic medical diseases, including diabetes-related leg amputations.
Roberson has tried to lose weight before, but it was hard. "You hit a couple of rough weeks and you kinda slough off." This time, Roberson says firmly, she will have to come back and answer to Rucker. That accountability, Rucker says will help her lose weight.
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Transcript
STEVE INSKEEP, HOST:
In Your Health on this Monday morning - favoritism in families, and how it can affect a child's behavior. First, free weight-loss counseling for seniors - about 13 million of this nation's 50 million seniors are considered obese. To help them lose weight, the Affordable Care Act included a new Medicare benefit offering free face-to-face weight-loss counseling in doctors' offices. But three years later, few Medicare patients are taking part. Sarah Varney reports.
SARAH VARNEY, BYLINE: Anne Roberson walks a quarter mile down the road each day to her mailbox in the farming town of Exeter, deep in California's Central Valley. Her daily walk and housekeeping chores are her only exercise and her weight has remained stubbornly over 200 pounds for some time now.
ANNE ROBERSON: You get to a certain point in your life and you say, well, what's the use?
VARNEY: But now Roberson, who is 68 years old, says the extra weight she's long carried around on her petite frame is taking a toll on her joints, her sleep and her mood.
UNIDENTIFIED WOMAN: She was 221 and then today she is 215.
VARNEY: On a recent morning, a nurse prepped Roberson for her first Medicare weight-loss counseling session, with her longtime primary care doctor, Mylene Middleton Rucker.
MYLENE MIDDLETON RUCKER: What I like to do is set doable goals, so, like, maybe 10 pounds in three months, you know what I'm saying?
VARNEY: A few extra pounds is little cause for alarm, but too much weight is especially hazardous for an aging body. Obesity raises the risk of heart disease, stroke, diabetes and can exacerbate bone and muscle loss. But even though Medicare now pays primary care doctors to counsel their obese patients, few doctors are taking advantage of it. Just 50,000 seniors participated in 2013.
SCOTT KAHAN: We think it's sort of a perfect storm of several factors.
VARNEY: Scott Kahan is an obesity medicine specialist at George Washington University. He says obese patients don't know they're eligible, and even most doctors don't know about the new benefit. And Kahan says doctors who want to intervene are often reluctant to do so.
KAHAN: It used to be thought that older patients don't respond to treatment for obesity as well as younger patients. People assume that they couldn't exercise as much or that they couldn't stick to diets as well, or the like, and actually, we've disproven that.
VARNEY: In fact, one study found 2 out of 3 patients lost 5 percent or more of their initial weight and kept it off for two years. So why aren't more people using the new Medicare benefit? Weight-loss specialists say it's because the government decided to limit counseling only to primary care offices. Bonnie Modugno is a registered dietitian in Santa Monica, Calif.
BONNIE MODUGNO: The problem with using only primary care providers is that they completely ruled out direct reimbursement for the population of providers who are uniquely qualified and experienced working with weight management. I think that was a big mistake.
VARNEY: Modugno says she's sympathetic with the government's concerns about widespread fraud - that just about everyone in the weight loss and fitness world wanted to be able to bill Medicare for obesity counseling. But she says doctors should be allowed to refer their patients to registered dieticians like her.
MODUGNO: Unless we change the nature of how this occurs, of how the counseling occurs, I don't see it being available to people in a meaningful way.
UNIDENTIFIED WOMAN: One-hundred-twenty over 80 - good.
VARNEY: Back in California's Central Valley, Medicare patient Anne Roberson is listening politely to Dr. Rucker's advice on weight loss.
RUCKER: Eating more vegetables - the fiber in the vegetables helps pull some of the fat out.
VARNEY: Dr. Rucker, who is obese herself, says she doesn't expect seniors to lose a lot of weight.
RUCKER: I think you will see weight loss of 10 to 20 pounds. Whether you're going to see people losing 50 to 100 pounds as they're older, I doubt it.
VARNEY: Still, even small amounts of weight loss matter, says Dr. Rucker.
RUCKER: I think we're going to see a decrease in some of the complications of chronic medical diseases.
VARNEY: Like heart disease and leg amputations that result from diabetes. As for Anne Roberson, it's not her first time trying to lose weight.
ROBERSON: I have, you know, tried several times before and I didn't have any accountability, and that was hard. You know, you hit a couple of rough weeks and then you just kind of slough off.
VARNEY: This time, Roberson says firmly, she'll have to come back and answer to Dr. Rucker. For NPR News, I'm Sarah Varney.
INSKEEP: This story is brought to you from our partner, Kaiser Health News. Transcript provided by NPR, Copyright NPR.
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