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Slide 1 - National Summit On Obesity Policy May 8-9, 2007 Morgan Downey Executive Vice President NAASO, The Obesity Society
Slide 2 - The Obesity Society 25 Years Old, Researchers and Clinicians Journal, Obesity Annual Scientific Meeting Advocacy: American Obesity Assn: SSA, IRS, CMS, FDA
Slide 3 - Scope The Progression through the health care sector that has taken us where we are. Survey of Policy Options in health care providers, payors and innovation
Slide 4 - Defining Terms Obesity is defined as excess adipose tissue Body Mass Index (BMI) most common measure of adiposity. Is ratio of height to weight, gender neutral. BMI of 25 is regarded as ‘ideal’. BMI of 30 (approx. 30 lbs over ideal) is threshold for obesity. BMI of > 40 is extreme or severe (formerly morbid)
Slide 5 - Increases in Morbid ObesitySturm, 2003
Slide 6 - ppt slide no 6 content not found
Slide 7 - The 5 Stages of Obesity 1 Avoidance – up to 1990s No medical specialty claims as own Not taught in medical schools Character flaw or disease
Slide 8 - 2. Denial mid 90s Identification of Leptin; growing prevalence identified by CDC Identification of genes Response: deny looming importance
Slide 9 - 3. Panic 1999-2005 Surgeon General’s report- 2001 Rapidly growing evidence of effect on t2d, cvd, and other comorbidities Payors drop coverage of bariatric surgery Congress does not include ob drugs in Part D Growing attention to childhood obesity Social Security Administration preserves morbid obesity as eligible condition for disability-2000 Internal Revenue Service recognizes obesity as a disease; expenses eligible for medical deduction-2001
Slide 10 - 4. Re-evaluation 2005-6 Centers for Medicare & Medicaid Services removes language that obesity is not a disease February 2005, CMS expands coverage of obesity surgery Surgeons establish Centers of Excellence BC BS North Carolina announces comprehensive coverage-2005
Slide 11 - Testing Waters 2006- Current National Commission on Quality Assurance tests measure National Quality Forum consideration Medicaid of West Virginia, Tennessee incorporate Weight Watchers FDA issues proposed new guidances for drug developers
Slide 12 - Policy Options in Health Care Research Education Prevention Treatment; access to treatment Consumer Protection Discrimination Disability
Slide 13 - Research Funding NIH/Obesity
Slide 14 - Research Funding/Population
Slide 15 - Research Policy Options Expand NIH centered research on obesity Expand USDA, DoD, VA, CDC research programs Establish National Institute of Obesity Research at NIH to focus research, translational research, prevention, pediatrics, health care economics
Slide 16 - Education Promote development of Obesity Medicine specialty Educate physician, non-physician health care providers on obesity Inform hospitals, nursing homes, rehabilitation centers of best practices, adapting to changing patient characteristics. Encourage development of “obesity educators” like Certified Diabetes Educators
Slide 17 - Prevention Improve obesity prevention research Incorporate assessments and evaluations in prevention programs (IOM) Expand prevention programs beyond children to College age population Pregnant mothers and fathers
Slide 18 - Treatment Support increased technological evolution in surgery Support fast track pharmaceutical products to treat obesity Support technology for better measurement of calorie consumption; obesity severity scale
Slide 19 - Access to Treatment Impose surcharge on obese person’s health insurance premiums – individual rating What constitutes an incentive? A punishment? Federal government as employer incorporate wellness and benefits into health plans Federal Programs Medicare Include drugs in Part D Cover physician, dietician counseling Medicaid Adequate coverage of surgery, drugs, counseling, follow-up care VA, DoD
Slide 20 - Consumer Protection FDA, FTC Enforcement of fraudulent, misleading claims Change in DSHEA: structure and function claims
Slide 21 - Discrimination Employment anti-discrimination protection for obese individuals Health care discrimination: non-availability of beds for persons with morbid obesity; inadequate equipment, staff Preferential non-treatment of persons with obesity because of complications, pay for performance, outcomes e.g knee and hip replacements, organ donations.
Slide 22 - Disability In addition to mortality, morbidity, emerging evidence of impact of obesity on disability. (Rand, Duke)
Slide 23 - Obesity and Disability RAND STUDY ADL Limitations increased by 13% for men and 24% for women 50-70 years old between 1985-2000 Trends in obesity could double disability rates by 2040 If obesity trends continue and no further dramatic improvements in medical care, future elderly will be substantially more disabled than current elderly.
Slide 24 - Issues: What is Obesity? Character Flaw Result of reckless food industry marketing A lifestyle choice A neuroendocrine disorder Unavoidable outcome of Western lifestyle Permanent alteration in the genome
Slide 25 - Observations Intervention among those who don’t need to manage their weight Obesity at BMI 30, beginning of risk Morbid/Severe obesity: highly motivated Epidemic we don’t have: bird flu: $3.6 billion Epidemic we do have: obesity: $600 million Bariatric Surgery: One of most powerful interventions in all of modern medicine: resolves multiple chronic diseases and health insurance efforts to restrict.