Obesity In The Health Care Bills

Having studied the latest research on the economics and politics of obesity, I've grown skeptical that a convincing case can be made that government-wide interventions can reduce obesity's cost contribution to the health care system in the near-term. The more one studies obesity itself and its effect on human beings, however, the stronger one feels a moral imperative to act. But how? If "we" knew, "we" would have figured it out by now.

The government's anti-obesity efforts are largely in a pre-decisional stage; numerous federal agencies are working on numerous projects; the Centers for Disease Control has been consumed by its response to H1N1 flu; the White House is quietly writing a blueprint for a national obesity strategy; states continue to experiment, but experimental programs are among the first to be jettisoned during times of economic duress. So far as the health care reform bills go, there are a bunch of obesity-related items that House and Senate negotiators have signed off on. They may -- or may not -- make a difference. In the near-term, they will serve to correct some of the systematic imbalances that feed the socioeconomic disparities in obesity prevention and treatment.

Here, per the Campaign to End Obesity, a multilateral consortium of business, health and academic groups, are the relevant line items in the House and Senate bills, listed in order (according to me) of impact.

Section 2713 of the Senate bill requires insurers to cover obesity screening and counseling; any and all conditions that receive an "A" or "B" level rating from the U.S. Preventative Services Task Force are required to be covered; in 2003, the USPSTF designated obesity as a "B" level phenomenon. At the very least, this requirement would remedy some of the information asymmetry that plagues obesity treatment. The House bill includes similar requirements. Medicaid programs would be required, under both bills, to cover obesity counseling.

The flashiest anti-obesity plank in the Senate bill is the new menu label regulations. Establishments of more than 20 or more locations -- i.e., big chains -- are required to list calorie counts on menus. Certainly, forcing people to look at calorie counts effects the psychology of purchase decisions, but there is no evidence from pilot projects that menu labeling persuades people to adopt healthier lifestyles.
The House bill includes $34 billion over five years for public health investments; childhood obesity and chronic disease prevention programs in poor, urban communities are likely to be the target of these grants. The Senate and House bills each include $15 billion for a "Preventative and Public Health Fund."

The Senate bill creates so-called "Safeway" grants for small employers to create employee wellness programs. Safeway, the grocery giant, has figured out ways to reduce its health care expenses by incentivizing employees to lose weight. It is not clear whether employees are healthier over the long-term, whether the program is fair to poorer employees, or whether, if implemented nationally, it would save as much as Safeway's CEO suggests.

Both bills require the Secretary of Health and Human Services to come up with a national anti-obesity strategy.

There is also funding in both bills to encourage basic scientific research about obesity; how to measure it, how to distinguish fat people from unhealthy fat people; how to better define amorphous conditions like "metabolic syndrome" and the like.