United States of Obesity: How Are States Battling Bulging Health Costs?

Efforts aimed at obesity prevention are well underway, but we are still a nation very uncomfortable with paying for services that could help treat the two-thirds of Americans who carry excess weight.
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There is no doubt that obesity remains a top health issue in the states as we enter 2013. According to the most recent "F as in Fat" report, a state-by-state obesity report card published by Trust for America's Health and the Robert Wood Johnson Foundation, obesity costs the United States up to $210 billion per year and obesity-related health conditions, such as heart disease and diabetes, are expected to rise significantly in coming years. With numbers like these, it only makes sense to ask: What are states doing to tackle obesity, and what trends are on the horizon in 2013?

To help answer this question, the Strategies to Overcome and Prevent (STOP) Obesity Alliance research team at George Washington University, for which I serve as director, focused our most recent "Weight and the States" bulletin on state-level legislative trends that took shape over the past year, including Affordable Care Act (ACA) implementation, obesity prevention efforts, and legislation designed to create healthier environments.

Long story short: Efforts aimed at obesity prevention are well underway, but we are still a nation very uncomfortable with paying for services that could help treat the two-thirds of Americans who carry excess weight, and prevent further downstream health complications and economic costs.

The ACA requirement that all state health insurance plans cover Essential Health Benefits (EHB) in order to participate in State Health Exchanges was seen by some as a long-sought opportunity for insurance coverage of evidence-based obesity treatments. Yet our research revealed that most states do not currently plan to include obesity intervention services as part of their EHBs. This finding is at odds with the United States Preventive Services Task Force's (USPSTF) recent "B" recommendation for obesity screening and intensive behavioral counseling, which would require states to cover these proven services. Adding further complexity to the issue, new guidance from the United States Department of Health and Human Services may "freeze" a state's EHB plan selection through 2016. For states that do not select an EHB plan that covers obesity-related services now, this would mean being locked into excluding those services for the next several years.

Not surprisingly, we found that states are focusing on obesity-prevention efforts, which range from approaching obesity as a family matter to operational and administrative changes to support that would streamline a state's efforts to advance legislation that focuses on supporting healthier environments. The trend toward "baby-friendly" hospitals and a family approach to healthy weight emphasizes the importance of going beyond personal responsibility to address obesity, one of three core principles that the STOP Obesity Alliance supports. Additionally, some states appear to be working on coordinating anti-obesity efforts through statewide coalitions, task forces, committees or state-level plans. During the 2012 legislative session, more than 450 obesity-related bills were proposed, ranging from taxes on sugary drinks to increasing the availability of healthy food in "food desert" communities. These bills underscored a common theme -- an interest in helping to create supportive environments where healthy choices are easier choices. Even with this interest however, only 62 of the proposals -- or about 14 percent of the bills introduced -- actually passed and were signed into law.

While I am hopeful about obesity prevention gaining even more traction in years to come, I am less optimistic about near-term progress for embracing proven interventions for those already affected by overweight and obesity. Marrying intervention and prevention is a critical component to addressing the full spectrum of obesity. After all, many people who struggle with overweight and obesity note that dropping a few pounds is not the real problem; rather, sustaining weight loss over time is the greatest challenge standing in the way of long-term health improvements.

As additional guidance unfolds at the federal level regarding ACA implementation, I am eager to see how states will weigh the short-term costs of covering obesity-related services against potential cost savings down the road. I'll be watching these trends throughout the coming year to see whether they continue or develop in new ways.

Scott Kahan, M.D., MPH
Director, STOP Obesity Alliance
Director, National Center for Weight & Wellnes

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