Opinion

Holistic Obesity Management Strategies

As we learn more about the role of chronic disease as a risk factor in the COVID-19 pandemic, innovations in the prevention and treatment of obesity, diabetes and other chronic diseases are important and timely news. According to the Centers for Disease Control and Prevention, about 80 percent of older adults have at least one chronic disease, and 68 percent have at least two. New medical advances can be part of the solution — but we need to do more to ensure older adults have access to the care they need for the best individualized options to manage chronic conditions and can access it at an affordable price. 

Chronic disease disproportionately impacts racial and ethnic minority groups and influences quality of life while placing a significant burden on our health care system. The economic impact of chronic diseases is estimated to be $3.7 trillion, inclusive of health care costs and lost economic productivity. Obesity and being overweight are nearly half of that cost, and often lead to other chronic diseases such as diabetes and heart disease. The costs are inclusive of direct costs such as prescriptions, procedures and other health care products and services, as well as those associated with the impacts on employment, mobility and other factors associated with well-being. 

This burden can be alleviated by managing and preventing chronic disease in part through evidence-based health promotion and disease prevention programs. Self-management programs that emphasize the patients’ central role in managing their disease have demonstrated improvement in health outcomes and fewer Emergency Department visits. Medicare payment should recognize the value of covering these management options so that all older adults are engaged in changing their behavior to improve their health, receive equitable person-centered, high-quality care, as well as other therapy options that are right for them.  

We recognize that a one-size-fits-all approach for older adults does not work, which is why individualized care is critical. There is a continuum of care for all chronic conditions — and lifestyle modification should always be the foundational step. For those who are seriously overweight and at risk, the continuum includes bariatric surgery as well as therapy. Anti-obesity medications may be an option for some individuals; however, this option is not currently covered under the Medicare Part D prescription drug benefit. 

It is time to change the conversation and acknowledge that maintaining the status quo poses serious consequences for older adults. Managing costly chronic diseases associated with obesity — which Medicare ends up footing the bill on — instead of addressing the root cause is not sustainable for the program nor older adults. When individuals become eligible for Medicare, the program must meet them where they are with a diverse selection of treatment options. It is imperative that we change these long-standing systemic health inequities which put older adults, especially those from racial and ethnic minority groups, at increased risk. With new advances on the horizon, it is time for a change so that we can more effectively support older adults, advance legislation and funding for healthy aging, and reduce the burden of chronic disease.

 

Ramsey Alwin joined the National Council on Aging as president & CEO in August 2020 and previously worked to introduce the Measuring American Poverty Act in Congress to redefine the federal poverty measure to better account for older adults’ costs of living.

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