Bariatric Times

Insights into Patient Pop with Obesity 2016

A peer-reviewed, evidence-based journal that promotes clinical development and metabolic insights in total bariatric patient care for the healthcare professional

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Bariatric Times • December 2016 • Supplement C C23 D espite the fact that there is Medicare coverage for intensive behavioral therapy (IBT) for obesity, there are serious limitations to coverage that may limit access to treatment for patients with obesity. For one thing, Medicare coverage applies only to IBT for obesity delivered in the primary care setting. Second, many private insurance companies do not offer the same coverage or may deny coverage for obesity treatment altogether. There are also some nuances to coverage that may be difficult to navigate or understand. For instance, a consultation with a dietitian would probably be denied to a patient with obesity, but would likely be reimbursed if the patient has chronic kidney disease or type 2 diables mellitus. Medicaid— unlike Medicare— does not cover IBT for obesity. Thus, more access, greater insurance coverage, and more streamlined rules for treating patients with obesitywould be helpful in giving patients access to care. Another unmet need is pharmacotherapy for obesity. There are fewer than a dozen of medications approved for the treatment of obesity, including about five newer ones approved in recent years. Compared to other disease states, such as hypertension or diabetes, this is a relatively small number. More drugs would expand the armamentarium and give clinicians more options to meet the individual needs of their patients. In considering drug therapy, it is crucial to recognize that the body has numerous and sometimes overlapping (and even redundant) pathways that address things like feelings of hunger and satiety, the extent to which food is stored as fat, how the body responds to physical activity. Drugs that can help interrupt some of these redundant physiologic pathways are likely going to emerge as being of crucial importance in the coming years. An emerging type of pharmacotherapy includes combination therapy. Combination therapy uses two or more agents to achieve the therapeutic goal. Combination products may be formulated as fixed-dose combination products or may be administered in "loose dose" fashion (i.e., two or more agents prescribed and taken separately). Drug safety and efficacy are improving, which are key features in offering optimal pharmacotherapy to patients. Pharmacotherapy must be considered in bariatric surgery patients, particularly when the medication(s) address pathways other than the ones addressed by the surgery. Coverage may not be available for this type of pharmacological therapy but this may change and it represents an important unmet need. There can also be regional differences in the U.S. that come into play. Obesity must be recognized as a disease with a medical approach; this means changing how it is viewed, developing the tools to treat it, and Insights into the Patient Population with Obesity: Assessment and Treatment Unmet needs in obesity Christopher D. Still, DO, FACN, Medical Director, Center for Nutrition and Weight Management; Director, Geisinger Obesity Institute; Medical Director, Employee Wellness, Geisinger Health System, Danville, Pennsylvania Scott Kahan, MD, MPH, FTOS Director, National Center for Weight and Wellness; Medical Director, Strategies to Overcome and Prevent (STOP) Obesity Alliance, George Washington University, Washington, D.C. Deborah Bade Horn, DO, President, Obesity Medicine Association; Medical Director, Clinical Assistant Professor, Center for Obesity Medicine and Metabolic Performance, UT McGovern Medical School, Houston, Texas facUlty discUssion

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