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Doctors Focusing on Senior Citizen Obesity, Now That
Medicare Pays
 Double
Problem: Seniors Overweight (58%) and Inactive
Nov. 8, 2004 – In July, the Centers for Medicare
and Medicaid Services announced they were changing their rules to
designate obesity as a disease and that Medicare would pay for
anti-obesity interventions. This has spurred new attention by the
medical profession on the treatment of senior citizens who are
overweight.
According to the National Heart, Lung and Blood
Institute, an estimated 18% of U.S. adults older than 65 are obese.
Another 40% are overweight, putting them at substantially increased risk
for diabetes, hypertension, heart disease and other illnesses.
"The thinking used to be if you got to be 60, 70,
or 80 and you were overweight, it wasn't going to hurt you," said Edward
Saltzman, MD, chief of the division of nutrition at Tufts Medical Center
in Boston. "That really isn't true."
Dr. Saltzman and other doctors focused on this
problem are featured in an article by Stephanie Stapleton in the current
issue of the AMNews, the online link between the American Medical
Association and their members.
The added attention by the Medicare shift doesn't
ease the burdens physicians face as they struggle to develop strategies
to make a difference, the article says.
"There are some things that are common sense when
dealing with older people and weight issues," said Dr. Sterling, also
chair of the AMA Council on Scientific Affairs. "But it can be much more
difficult to change their behavior, and the stakes are much higher,
because the secondary medical problems are more common."
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Medicare Decides
Obesity is Health Danger They Will Pay to Correct
July 15, 2004 – A new
Medicare coverage policy was announced today that will remove
barriers to covering anti-obesity interventions, “if scientific
and medical evidence demonstrate their effectiveness in
improving Medicare beneficiaries' health outcomes.”
More... 7/15/04* |
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Helping
older patients take steps
Some simple ways to motivate people to
get moving:
> Assess how much physical activity your patients are
getting and explore reasons that they aren't more active. A
recent study found that only half of all adults were asked about
their exercise habits by their health care professional. Older
patients were asked less often than younger patients. Patients
who had been asked reported being more active than those who
were never asked.
> Include patient goal-setting, written exercise
prescriptions, individually tailored physical activity regimens
and mail or telephone follow-up as part of patient care.
> Refer patients to community resources where they
can join group activities to promote and reinforce physical
activity.
Source: "Physical Activity and Older Americans:
Benefits and Strategies," Agency for Healthcare Research and
Quality and Centers for Disease Control and Prevention, June
2002 |
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Many experts talk about the problem in terms of
twin epidemics: obesity and inactivity.
Between 28% to 34% of adults ages 65 to 74 and 35%
to 44% of adults older than 75 engage in no leisure-time physical
activity at all, according to the Centers for Disease Control and
Prevention. This fact further complicates this demographic group's
weight-control efforts. Not only are these patients more likely to be
sedentary, but as people age, their metabolisms slow. Interventions,
therefore, have to operate on two tracks.
"I don't just think in terms of weight loss
anymore," said Howard Eisenson, MD, a family physician who is the
director of the Duke Diet and Fitness Center in Durham, N.C. Instead,
diet and nutrition as well as physical activity are two sides of the
same coin, he said.
But the stumbling blocks are many. Physicians often
recommend walking. However, wear-and-tear joint pain can limit a
patient's ability to follow through, explained Denise Bruner, MD, a
bariatrician in private practice in Arlington, Va., and a former
president of the American Society of Bariatric Physicians. They might
fear walking outside because of crime or a lack of sidewalks. People
also sometimes have vision or balance problems that put them at risk of
falling.
When it comes to eating habits, older patients can
have diminished taste buds, which tend to lure them toward the sweet and
salty. Their negative patterns are well-established. And often, they
live on fixed incomes, and healthy food choices are usually more
expensive.
And some patients are on medications that either
drive their weight up or prevent losses.
But the cards seem stacked against older patients.
It's the arthritis that makes it hard to exercise, the habits ingrained
over many years that are difficult to break, and the reality that older
folks simply tend to lose weight more slowly.
"One of the limitations to a weight-control effort
-- particularly if it is non-surgical -- is people want to hop on the
scale every few days and see the needle dropping. If they don't, it can
derail their efforts," Dr. Eisenson said.
Thus, keeping these patients focused on the prize
is critical.
For the full story in the AMNews -
click
here
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