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Nutrition Policy Assignment On Treat and Reduce Obesity Act of 2019

Natalia Sarmiento

FNES 368: Life Cycle Nutrition

Professor Laura Kovacs

April 5, 2021
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Obesity is a huge cost to our economy, costing $210 billion per year (Sharma, 2020). The

Treat and Reduce Obesity Act (TROA) address the obesity crisis in a clinically and financially

sound manner. TROA is a bipartisan bill that is supported by both Republicans and Democrats,

gaining traction as obesity advocates around the country lobby to get it passed (Obesity Action

Coalition, 2019). TROA, if passed, would expand Medicare recipients' insurance coverage to

include obesity screening and treatment by several healthcare professionals that specialize in

obesity care, such as specialized nurse practitioners, physician assistants, clinical nurse

specialists, dietitians, obesity medicine specialists, endocrinologists, bariatric surgeons, and

psychologists or psychiatrists (Obesity Action Coalition, 2019).

Obesity is a partisan problem in and of itself because it affects everyone. There's no

denying that there's a pressing need to convince the public, including lawmakers in the United

States, that obesity must be taken more seriously. TROA's passage is a big step in the right

direction. Directly, TROA would help those who receive Medicare benefits which is fantastic,

given that seniors account for a large percentage of Medicare recipients, and almost four out of

ten are obese. Just about 1% of people will get help for obesity. And if you don't have Medicare,

you will be able to benefit from improvements to health policies that are modeled after Medicare.

Better healthcare access means a better quality of life for all (Obesity Action Coalition, 2019).

Obesity is treated with intensive behavioral therapy (Ventrelle, 2017). IBT helps patients

through nutritional assessment and intensive behavioral counseling that promote sustained

weight loss through high-intensity diet and exercise interventions. Jennifer Ventrelle, MS, RDN

on Today's Dietitian (2017) states that Medicare includes IBT for obesity, described as a body
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mass index (BMI) of 30 kilograms per meter squared, for the prevention or early detection of

disease or disability, beginning November 29, 2011. The following are the components of IBT

for obesity stipulated by the Department Of Health And Human Services Centers for Medicare &

Medicaid Services (2012):

● Screening for obesity in adults using measurement of BMI, which is calculated by

dividing weight in kilograms by the square height in meters;

● Dietary (nutritional) assessment; and

● Intensive behavioral counseling and behavioral therapy to promote sustained weight loss

through high-intensity interventions on diet and exercise.

The USPSTF 5A approach must be followed by each obesity IBT: Assess, Advise, Agree, Assist,

Arrange. Medicare will cover up to 22 IBT sessions for obesity in a year.

Academy of Nutrition and Dietetics (2019) stated that under the current law IBT is only

covered by Medicare if it is delivered by a primary care provider in a primary care setting;

nutritionists, bariatrician, endocrinologists, psychiatrists, and clinical psychologists are not

permitted to provide IBT. On the other hand, primary care professionals are constrained in terms

of time, experience, and expertise to carry out high-intensity interventions that have been

clinically validated to achieve the best outcomes (Sharma, 2020). Dietary therapy provided by a

professional educator such as a registered dietitian is more successful than that provided by a

primary care clinician, according to the Institute of Medicine, and the US Preventative Services

Task Force (USPSTF) has recommended that IBT not be restricted to primary care providers in

the primary care setting. RDs are well-equipped to conduct BMI evaluations, are the

best-qualified to conduct accurate nutritional assessments, and are often trained in behavioral
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therapy; they rarely obtain CMS reimbursement directly for IBT in most clinical practices

(Ventrelle, 2017).

The TROA 2019 could have a positive impact on nutrition professionals. To begin,

TROA gives CMS the authority to expand beneficiary access to IBT by allowing more types of

qualified health care providers like RD’s for example to provide IBT services (Obesity Care

Advocacy Network, 2019). Therefore, as future RD’s we will be able to reach out to more

patients in our healthcare setting and help improve the patient’s quality of life. This is consistent

with the USPSTF's recommendation that IBT will deliver efficient, demonstrable outcomes for

obese patients, and that these programs are more effective when referred to trained healthcare

professionals with adequate obesity management training (Obesity Care Advocacy Network,

2019). The challenge for RD’s is to get the Centers for Medicare and Medicaid Services (CMS)

to provide reimbursement for the treatments and also provide the appropriate time for each

behavioral therapy consultation since a 15-minute counseling intervention will not be as effective

as a 30 to 40-minute consultation. RDs need sufficient time to take 24-recalls, develop a meal

plan for patients, and provide appropriate therapy intervention, and 15 minutes is insufficient to

provide each patient with the attention they require. RDs also want to be compensated for their

work. These are some of the drawbacks that CMS should address.

Second, the TROA gives Medicare Part D the authority to cover FDA-approved

weight-loss drugs that are used in conjunction with IBT. The bill establishes a system of

structured, interprofessional services that enhances quality and effectiveness while lowering

costs (Obesity Care Advocacy Network, 2019). If the TROA gives Medicare Part D the authority
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to cover FDA-approved weight-loss medications as dietitians we wouldn’t be able to prescribe

them because dietitians don't write prescriptions, however, we can successfully treat patients by

prescribing dietary and lifestyle changes (Rose, 2020). Most dietitians tailor diet and lifestyle

prescriptions for each patient. Although our methods may not be able to cure every patient, they

are typically successful enough to change the direction of conventional physician management.
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References

Academy of Nutrition and Dietetics (2019). Treat and Reduce Obesity Act (S.595/H.R. 1530)

[Leave Behind For Member of Congress].

https://www.eatrightpro.org/-/media/eatrightpro-files/advocacy/legislation/issue-brief-tro

a2021_final.pdf?la=en&hash=DA1946BD29FA4E09C0CC8ED42DAF8B50CCCA86ED

Batsis, J. A., Huyck, K. L., & Bartels, S. J. (2015, January). Challenges with the Medicare

obesity benefit: practical concerns & proposed solutions. Journal of general internal

medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4284254/.

Intensive Behavioral Therapy (IBT) for Obesity. Department Of Health And Human Services

Centers for Medicare & Medicaid Services. (2012).

https://www.cigna.com/static/docs/medicare-2018/ibt-obesity.pdf.

MCD. Decision Memo for Intensive Behavioral Therapy for Obesity (CAG-00423N). (2011,

November 29).

https://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?&Nc

aName=Intensive+Behavioral+Therapy+for+Obesity&bc=ACAAAAAAIAAA&NCAId

=253.

Obesity Care Advocacy Network (2019). Please Support The Treat And Reduce Obesity Act
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of 2019 (S 595/HR1530).

https://www.endocrine.org/-/media/endocrine/files/advocacy/society-letters/2019/june-20

19/06262019-final-ocan-los-for-troa.pdf.

Rose, S. (2020, July 9). Can Dietitians Write Prescriptions? Sort Of! My Diet Matters.

https://mydietmatters.com/can-dietitians-write-prescriptions-sort-of/.

Sharma, P. (2020, January 1). The Treat and Reduce Obesity Act of 2019. Bariatric Times.

https://bariatrictimes.com/treat-and-reduce-obesity-act-of-2019/.

Treat and Reduce Obesity Act of 2019, H.R. 1530, 116th Cong. (2019),

https://www.congress.gov/bill/116th-congress/senate-bill/595

Ventrelle, J. (2017, March). CPE Monthly: Intensive Behavioral Therapy for Weight

Management - Today's Dietitian Magazine. Today's Dietitian.

https://www.todaysdietitian.com/newarchives/0317p44.shtml.

You Should Care about the Treat & Reduce Obesity Act (TROA). Obesity Action Coalition.

(2019, February 12).

https://www.obesityaction.org/community/news/access-to-care/you-should-care-treat-red

uce-obesity-act-troa/#:~:text=The%20Treat%20and%20Reduce%20Obesity,to%20push%

20it%20through%20Congress.&text=There's%20no%20question%20that%20a,to%20be

%20treated%20more%20seriously.