People who are very heavy and are on Medicare will soon be eligible for a new kind of help—personalized obesity counseling at no charge. In terms of health-care coverage, this is a pioneering move, since studies have shown that weight-loss counseling can be an effective aid for losing weight and it’s a benefit that most insurance companies don’t offer.

On the other hand, I think it’s fair to wonder just how effective a government weight-loss counseling program will really be—especially with Medicare’s infamous budgetary problems. For the many people who have tried again and again to lose weight, a free program that doesn’t work would be a cruel “benefit,” indeed. So I decided to do some reconnaissance for Daily Health News readers by calling Nancy Copperman, RD, CDN, director of public health initiatives in the office of community and public health at the North Shore-LIJ Health System in New York, because she’s an obesity counselor with 20 years of experience.

WHY THE CHANGE OF HEART?

Copperman was realistic about one of Medicare’s reasons for suddenly providing the service—obesity’s horrible effects on people’s health can be super-expensive for health insurers to treat. In fact, according to Shape Up America!, a nonprofit founded in 1994 by former US Surgeon General C. Everett Koop to raise awareness about obesity, health-care costs attributed to the issue will increase from $198 billion per year to as much as $344 billion by 2018 if Americans don’t get serious about the problem. And senior citizens are just as super-sized as the rest of the American population, with 37% of men and 42% of women over age 60 carrying a body mass index (BMI) of 30 or higher, which classifies them as obese. By providing coverage for obesity counseling, Medicare probably hopes to both reduce obesity and reduce its own costs, said Copperman.

WHAT’S INCLUDED?

As we might expect, there are conditions. Here’s how it works: Using a height-weight calculation, patients will first be screened to determine whether their BMIs are 30 or above—so those classified as overweight but not obese (a BMI between 25 and 29) will not qualify.

Those classified as obese will be eligible for in-person counseling (the patient visits the doctor’s office). The sessions are once a week for a month and typically last 30 to 45 minutes. And then each person is entitled to one such visit every other week for the following five months. Participants who lose at least 6.6 pounds during the first six months are then eligible to receive additional monthly counseling for another six months. But those who don’t lose that much weight would need to wait six months before being reevaluated for the program.

It seems simple, Copperman said, but there are pitfalls. For one thing, Medicare will pay for the counseling only if it’s given in a primary care setting—and Copperman has a big problem with that. It means that the people most likely to be doing the counseling will be MDs, nurses, nurse-practitioners and physician assistants—but these professionals aren’t typically trained in obesity counseling the way that registered dieticians and certain psychologists and physical therapists might be, she said. And no particular training or certification is required by Medicare for them to give you the counseling. Medicare will pay for a registered dietitian, a psychologist or a physical therapist to counsel you about obesity, but only if that particular specialist happens to work in the primary care office.

SUCCESS STRATEGIES

Medicare provides a rough framework from which counselors are supposed to work, but what each counselor chooses to talk about, specifically, with each patient is up to the counselor. There is plenty of room for improvising because the course of action that is taken depends on the particular patient’s risk factors, habits and goals.

To give you a better idea, though, of what a typical counseling session might entail, Dr. Copperman walked me through some strategies that she would use that follow Medicare’s framework…

  • Analyze the patient’s diet. This will include what the patient eats…how much…when…and how it’s prepared, among other aspects.
  • Talk about exercise. They will discuss the patient’s current physical abilities…limitations…experience with exercising…access to exercise facilities (including places to just get outside and walk!)…and other aspects of physical fitness.
  • Overcome barriers and develop an action plan. The counselor will ask the patient questions such as, “How would you like to start—by eating out less? Drinking more water? Sitting less?”…“How confident are you?”…“Who might sabotage your efforts?”

According to Medicare, Medicare beneficiaries who meet eligibility requirements in the “national coverage determination” are eligible for this service. If you’re not sure, call your provider or Medicare at 800-633-4227. The exact start date of the program is unknown (because Medicare is still figuring out how much doctors will be reimbursed for it), but it has been approved.

You may be wondering why the Medicare counseling program has set its six-month weight-loss requirement at 6.6 pounds—which is not only a weirdly unround number, but seems awfully modest for someone who is truly obese. The reason is that studies have shown that people who lose at least 6.6 pounds on such programs—which can lead to small but tangible improvements in their overall well-being—often keep the weight off long-term, Copperman said. So even if you’re not over 65, it may be a smart move—for both your waistline and your bottom line—to give obesity counseling a try.