Treat and Reduce Obesity Act
H.R. 2404/ S. 1509
Molly Koch, Rachel OConnor, Aubrey Stueckler
BACKGROUND
The Treat and Reduce Obesity Act, introduced in 2015, would amend title
XVIII of the Social Security Act. It would provide Medicare beneficiaries
and their healthcare providers with meaningful tools to reduce obesity by
improving access to weight-loss counseling and new prescription
medications for chronic weight management. The Treat and Reduce
Obesity Act, also known as TROA, will requires the Secretary of Health
and Human Services to make recommendations on how to combat the
obesity epidemic every two years to Congress.
The Centers for Medicare and Medicaid Services (CMS) will have the
authority to further develop existing Medicare benefits for intensive
behavioral therapy (IBT) which includes counseling. In addition, TROA
will allow a variety of qualified health care providers to offer IBT. IBT is
defined as, behavioral counseling and therapy to promote sustained
weight loss through high intensity interventions on diet and exercise.
TROA was introduced into the House of Representatives on May 18,
2015 and the Senate on June 4, 2015; it was not enacted. To date, the
latest action was that the House referred TROA to the Subcommittee on
Health in June of 2015. The 2017 Treat and Reduce Obesity Act plans to
be reintroduced in the 115th Congress.
Current Treatment Options:
Prescriptions: Medicare Prescription Drug, Improvement, and
Modernization Act of 2003 (MMA), clarified in 2008, stating there
is no Part D (Voluntary Prescription Drug Benefit Program)
coverage of agents used for weight loss medications, even if used
for non-cosmetic purpose such as morbid obesity.
Therapies: Medicare currently covers intensive behavioral
therapy but this is limited to primary care providers in a PCP
setting.
Professionals: Primary care physicians, nurse practitioners, CNS,
and physician assistants are allowed to provide IBT as of 2011
through CMS.
Proposed Treatment Options through TROA:
Prescriptions: Medicare Part D would cover FDA-approved
weight loss drugs for chronic weight management of individuals
who are obese (BMI of 30 or more) or individuals who are
overweight (BMI of 27-29.9) with one or more co-morbidities.
Recommendation Development: The Department of Health
and Human Services (HHS) is required to report back to Congress
on steps needed to implement the Act as well as to provide
Congress with recommendations for better coordination of US
government efforts on obesity after two years.
Professionals: A physician who is not a PCP, an evidence-based,
community-based HHS-approved lifestyle counseling program,
physician assistant, nurse practitioner, clinical nurse specialist,
clinical psychologist, registered dietitian, or a nutrition professional
would be allowed to conduct IBT after referral.
Keene State College Dietetic Internship
April 24, 2017
Obesity and chronic conditions go hand-in-hand. This chart compares the percentage of
spending on people with chronic conditions to the percentage of non-institutionalized
population with >1 chronic condition. It shows that people with chronic conditions account
for 84% of national health care expenditures and 99% of Medicare spending. For further
details, reference Impact on Public section.
IMPACT ON RDs
With the enactment of TROA, Registered Dietitians, among other qualified health professionals,
would be reimbursed by Medicare for intensive behavioral therapy in the treatment of obesity. This
would provide more precise care, plan interventions, and provide nutrition education for weight loss
for Medicare beneficiaries.
By allowing more qualified experts in the field to provide counseling and behavioral therapy,
Registered Dietitians will be able to expand their markets and see more patients. As part of TROA,
Registered Dietitians are not required to be a part of a physicians office, hospital, or outpatient
setting. They will be able to have any office setting in order to practice and receive reimbursement
given the patient is referred by the primary care physician and the setting complies with HIPAA.
There will be a collaborative effort between primary care physicians and other practitioners to respect
HIPAA, have a referral plan, and have a combined treatment plan regarding the therapy
provided. This will include the Registered Dietitian in the treatment plan of individuals who need
weight loss resources.
IMPACT ON PUBLIC
Quality of Life: The Act states in its findings that the CDC reports 34%
of adults aged 65 years and older were obese between 2009 and 2012. This
is about 15 million people in the United States. By enacting TROA, the
public will be provided with a full array of treatment options, including
education on diet and exercise. The USPSTF found that IBT helps people
with obesity lose significant weight and decrease their risk for
cardiovascular disease and diabetes. IBT provided by RDs for 6-12 months
yields significant weight loss of up to 10% of body weight, which is
typically maintained beyond one year. Additionally, studies show that RD-
provided IBT for people with obesity or are overweight yields significant
weight loss at an appropriate rate of 1-2 pounds per week.
Healthcare Spending: Currently, obesity accounts for 21% of healthcare
spending which totals $210 billion per year. With TROA, healthcare costs
would decrease long-term. A Medicare beneficiary with obesity costs
$1,964 more than a beneficiary of normal-weight. In the absence of
obesity, Medicare spending would be 8.5% lower and Medicaid spending
would be 11.8% lower. (Brill, 2013) Obesity rates can decrease with
increased access to treatment, access to professionals, and access to new
and more medications.
Medications: Currently, only two weight-loss medications are covered
under Part D. An increase in quantity and quality of drug therapy would
add to the beneficiarys success.
Without TROA: There will not be access to a variety of FDA-approved
weight loss medications or healthcare experts to provide IBT. There will be
no lower-cost, middle ground for patients with moderate needs.
Research documents the harmful health effects of excess body weight,
increasing the risk for conditions such as diabetes, hypertension, heart
failure, dyslipidemia, sleep apnea, hip and knee arthritis, multiple cancers,
renal and liver disease, musculoskeletal disease, asthma, infertility, and
depression. Obesity rates will only continue to rise without the passing of
the Treat and Reduce Obesity Act.
RESOURCES
Brill, Alex. The Long-Term Returns of Obesity Prevention Policies. A Campaign to End Obesity, Matrix
Global Advisors. April 2013.
Evidence-based Nutrition Practice Guideline on Adult Weight Management (2006) at
http://www.andeal.org/topic.cfm?cat=3014 and copyrighted by the Academy of Nutrition and Dietetics.
Accessed 27 March 2017.
Idaho Academy of Nutrition & Dietetics (2016). The Treat and Reduce Obesity Act H.R. 2415 S. 1184.
Retrieved from http://www.eatrightidaho.org/app/uploads/archive/uploads/Leave-Behind-Obesity.pdf
Kaiser Health News, Appleby, J. (2012). Figure 4. People with Chronic Conditions Account for 84% of
National Health Care Dollars and 99% of Medicare Spending Medical Expenditure Panel Survey, 2006;
Robert Wood Johnson Foundation, Chronic Care: Making the Case for Ongoing Care, February 2010.
Obesity Action Coalition (2016). The Treat and Reduce Obesity Act of 2015 (H.R. 2404/S. 1509) Fact
Sheet. Retrieved from http://www.obesityaction.org/wp-content/uploads/HR-2404-S-1509-TROA-Fact-
Sheet.pdf