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Running head: HEALTH POLICY ANALYSIS: OBESITY
Health Policy Analysis Paper: Obesity
by
Name
Liberty University
March 24, 2022
HEALTH POLICY ANALYSIS: OBESITY 2
Overview and the Severity of the Health Problem
Weight gain and obesity are problems prevalent in patients with schizophrenia compared
to the general population. .The prevalence of weight gain and obesity in people with
schizophrenia has been reported to be anywhere from 1.5 to 4 times higher than in the general
population (Faulkner, 2010). .Even though weight gain and obesity may be a problem for
individuals with schizophrenia before the start of treatment with antipsychotics, studies indicate
that use of second-generation antipsychotics (SGA) leads to significant weight gain in this
population (Manu et al., 2015; Panariello, De Luca, and de Bartolomeis, 2010; Vieweg, and
Hasnain, 2012).
Although excess body weight in patients on antipsychotics has been documented for
over 40 years, with 40-80% of such individuals experiencing weight gain (Maayan, and Corell,
2012), this significant side effect of SGA is particularly problematic in patients with
schizophrenia. The SGA-induced weight gain and obesity in patients with schizophrenia has
become a nationwide epidemic that lurks in the American population and a global problem as
well. Therefore, there is a need to address this problem due to its negative health implications,
such as increased risks for the onset of chronic diseases such as type 2 diabetes mellitus,
hypertension and dyslipidemia, which are risk factors for cardiovascular disorders which affect
the quality of life in this population including premature death (Manu et al., (2015).
Panariello, De Luca, and de Bartolomeis, (2010) reported that significant weight gain
related to the use of SGA may affect the compliance of pharmacotherapy in patients with
schizophrenia because of the stigma associated with obesity and negative body image. .Vieweg
and Hasnain, (2012) and Weiden, Mackell, and McDonnell, (2004) also posit that there is a
significant, positive association between obesity and subjective distress from weight gain and
HEALTH POLICY ANALYSIS: OBESITY 3
medication noncompliance. Maayan and Corell, (2012) and Joe and Lee, (2016) indicated that
medication noncompliance is a major barrier to better health outcomes for people with
schizophrenia and is a major risk factor for relapse. .Relapse often leads to the reoccurrence of
psychotic symptoms. This eventually may lead to hospitalization, which further complicates the
treatment of patients with schizophrenia.
Weight gain and obesity is not only a problem unique to patients with schizophrenia.
This is also a systemic problem that plagues people from low-to-middle income countries, often
without much legislation to address the upsurge in noninfectious diseases associated with excess
weight. In the United States alone, currently, two-thirds of the adult population are affected by
excess weight/obesity and the associated comorbid diseases. One of the major barriers to
effective legislation addressing the obesity epidemic has been the lack of cost-effective solutions
that also address the nuances of insurance coverage and rising Medicare/Medicaid costs. Obesity
and weight gain have often been addressed with systematic support for exercise and dietary
modifications. However, there is a need for a greater emphasis on legislation that promotes
harmonized, interdisciplinary care.
Overview of the bill and Stakeholders
Legislation in the United States has often lagged in addressing the obesity epidemic. This
is even worse when it comes to people with mental illness like patients with schizophrenia.
Without perceived support from the Senate, bills regarding obesity have been ignored largely due
to poor lobbying and diverted attention to other healthcare acts. However, in 2013, the first draft
of the Treat and Reduce Obesity Act was introduced to the Senate by Senator Tom Carper (D-
DE) and Lisa Murkowski (R-AK) as well as U.S. Representatives Ron Kind (D-WI) and Bill
Cassidy (R-LA) (Obesity Medicine Association, 2013).
HEALTH POLICY ANALYSIS: OBESITY 4
According to the Treat and Reduce Obesity Act (TROA), the goal is to empower
healthcare providers with “tools to treat and reduce obesity by improving access to obesity
screening and counseling services, and new prescription drugs for chronic weight management”
(Obesity Medicine Association,2013, par.1). Only patients covered by Medicare and Medicaid
will be beneficiaries of the services offered by healthcare providers through provisions in this
act. To this end, patients with schizophrenia on SGA who are obese will benefit from this act. In
addition to broader coverage for prescription drugs for chronic weight management, one of the
highlights of this act is the increased access to intensive behavioral counseling. Since patients
with mental illnesses such as schizophrenia often suffer from increased weight gain due to
treatments such as second-generation antipsychotics, the Treat and Reduce Obesity Act sets a
precedent for future interventions that address the co-morbidity of obesity and mental illness.
With greater reliance on other qualified health practitioners such as nurse practitioners
and PAs, there has been a need to remove barriers that health practitioners who are not
physicians face when wanting to provide treatment for obesity through Intensive Behavioral
Treatments (IBTs). .In the 2015 version of the bill, the Senate added an amendment (Amendment
title XVII) which authorized 1) physicians who are not primary care physicians 2) community-
based lifestyle counseling programs and 3) nurse practitioners, physician assistants, clinical
nurse specialists, clinical psychologists, and registered dieticians to provide IBT (Congress.gov
S.1509, 2015).
Addressed in both the 2015 and 2017 version of the Treat and Reduce Obesity Act is also
the authorization for the Department of Health and Human Services to “cover under Medicare
part D (Voluntary Prescription Drug Benefit Program) medication for treatment of obesity or for
weight loss management for an overweight individual with one or more related comorbidities”
HEALTH POLICY ANALYSIS: OBESITY 5
(Congress.gov S.1509, 2015, par.3). Under this authorization, the authors and proponents of the
bill are targeting patients who are covered under Medicare as the ultimate goal is to improve the
quality of life for seniors who are living longer and suffering the consequences of comorbid
diseases associated with weight gain and obesity.
Promises/Expected Outcomes
In addition to improving population health outcomes, the Treat and Reduce Obesity Act
promises the public increased funding and improved treatment options for healthcare providers
such as counseling and access to weight loss medications. Promoters of the bill will likely be
members of both parties of the House and Senate who have promised that they will improve the
quality of life of their constituents by helping to curtail the obesity epidemic as well as reduce
healthcare spending associated with treatment for chronic diseases. With such a bill, there is
increased the likelihood for a bipartisan approach as the Treat and Reduce Obesity Act addresses
an issue that affects over 90 million people in the United States alone and costs the U.S. over
$200 billion per year in taxpayer money (Obesity Society, 2017).
Although the bill authorizes all non-physician health practitioners to provide IBTs to
patients, research by the Academy of Nutrition and Dietetics has shown that patients who are
treated by Registered Dietitian Nutritionists (RDNs) exercise more than patients who were not
treated through IBT by RDNs and also more likely to attain weight loss that is considered
clinically significant ( Academy of Nutrition and Diabetics, n.d). Such results show that with
increased interdisciplinary care, progress toward curbing the obesity epidemic and associated
comorbidities may be accelerated. Therefore, non-physician health practitioners are likely to be
proponents of this bill as it incorporates their expertise and acknowledges their role in ensuring
its efficacy achieving weight loss for patients who receive IBT and counseling. Additionally,
HEALTH POLICY ANALYSIS: OBESITY 6
with increased reliance on RDNs, for instance, there are an anticipated reduction healthcare costs
associated with high provider fees as RDNs' fees are typically 15 percent lower those of primary
care providers ( Academy of Nutrition and Diabetics, n.d). Other lobbying groups such as the
U.S. Preventive Services Task Force (USPSTF) who are proponents of the Medicare IBT
coverage policy will likely also be supporters of this bill (American Association of Clinical
Endocrinologists, 2017). It removes the current barrier that IBT can only be provided by a
primary care physician. Such narrow coverage has led to reduced efficacy of their efforts.
Additionally, pharmaceutical companies as well as scientists in research and development
(R&D) would likely favor the passage of this bill as the amendment to cover obesity medications
or “weight loss drugs” under Medicare part D will allow medications that have been immovable
in clinical trials to have a greater chance of introduction into the market. The passage of this bill
will also allow the FDA to approve promising obesity medications and other therapies which will
validate current scientific advancements and finally allow research on weight loss management
to become a funding priority (American Association of Clinical Endocrinologists, 2017)). With
more options for therapies, patients suffering from obesity and mental illnesses that result in
weight gain will have increased accessibility to a range of medications of varying costs thus
increasing the likelihood treatment.
Problems
Ironically, some physicians may be against this bill due to its focus on providing greater
access to pharmacologic therapies while physicians have historically solely supported counseling
for weight loss coupled with exercise. Physicians have also focused on treating comorbidities
associated with obesity rather than providing treatment options for obesity often due to their lack
of similar training as Registered Dietitian Nutritionists (RDNs). .Although this bias is due to lack
HEALTH POLICY ANALYSIS: OBESITY 7
of substantive data on the efficacy of an interdisciplinary approach to care based on intensive
behavioral therapy (IBT) and exercises for patients, such bias is enough to curtail the efforts of
the Treat and Reduce Obesity Act.
Unintended Consequences
Increased coverage for patients under Medicare part D means insurance companies that
offer Medicare plans are likely to protest their increased costs. This could result in increased
premiums for their customers who are not covered by Medicare in order to offset their costs. One
of the major unintended consequences is improper and uncensored prescription of weight loss
medications due to the removal of previous barriers against non-physician healthcare providers
providing weight loss management treatment options.
Recommendations
The Treat and Reduce Obesity Act sets a precedent for not only the acknowledgment of
obesity as a multifactor disease but also as one that can be treated by incorporating various
disciplines and therapeutic measures. However, in order for its provisions to be accessible to all
the target populations, this bill must undergo various other amendments that address its financial
feasibility. Currently, 2013, 2015, and 2017 versions of the TROA do not address how providers
will be reimbursed. Therefore, I recommend a financial and clinical evaluation of the efficacy of
the bill that will assess whether healthcare providers are adhering to the treatment options
provisioned under the TROA in a cost-effective manner. There is a need for community-wide
metrics that will provide epidemiological data on whether patients suffering from obesity and
mental illnesses such as schizophrenia are indeed benefiting from IBTs and increased access to
weight loss drugs.
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References
American Association of Clinical Endocrinologists (2017). Cosponsor the treat and reduce
obesity act (H.R. 1953/S.830). AACE Legislative Fact Sheet. Retrieved from
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..Academy of Nutrition and Diabetics (n.d). Treat and reduce obesity act. Eat Right Pro.
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reduce-obesity-act
Congress.gov S.1509 (2015). Treat and reduce obesity act of 2015. Retrieved from
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HEALTH POLICY ANALYSIS: OBESITY 9
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