Future and implications of reimbursement for obesity treatment.

Obesity has been defined as a distinct disease by the World Health Organization, National Institutes of Health, Centers for Disease Control and Prevention, and the American Dietetic Association. In the United States, a major reimbursement challenge is to promote acceptance of obesity as a chronic disease and acceptance of its treatment by health management organizations, private insurers, and the government. The United States health care system is focused on treating individual obesity-related diseases, but does not treat obesity as the underlying cause. Reimbursement of obesity treatments using "condition coverage" based on the presence of other diseases does not allow obesity to be treated independently as a disease in itself. It is necessary to make major investments in research to determine the best methods and to match the treatment with the individual, to prevent obesity in vulnerable populations, and to develop more effective drugs and treatments for those already overweight or obese. There should be a more detailed analysis of the cost of obesity, costs associated with obesity and obesity-related disease treatment, and costs of inaction. The obesity epidemic is too large to be ignored. Health care professionals have a duty to be informed about the disease and to advocate for patients who need help. Registered dietitians can be key players in delivering obesity treatment.

Survey of antiobesity legislation: are these laws working?

PURPOSE OF REVIEW: Obesity is well recognized as a major public health crisis throughout the USA. In recent years, governmental bodies at the federal, state and local levels have enacted policies intended to prevent the transition to obesity. Researchers have had the opportunity to study these policies and evaluate their impact on prevention of obesity. RECENT FINDINGS: Most public policies have been directed principally, but not exclusively, to the prevention of obesity in school-age children. Interventions have been directed to encouraging breast-feeding, to changing school lunches, limiting access to sugar-sweetened beverages, encouraging physical activity, changing the composition of competitive foods and affecting food advertising directed at children as well as collecting BMI information. Efforts more directed at adults include encouraging workplace wellness programs and improving the nutrition label on packaged foods with front-of-package labels and caloric information on restaurant menus. SUMMARY: For the most part, evaluations of the interventions reveal weak or modest benefits. The actual picture might be less positive due to the poor quality of research and publication bias. Push back by industry and others will require higher quality experimental and real world studies. All interventions fail to accommodate the multifactorial aspects of obesity.

Is there a path for approval of an antiobesity drug: what did the Sibutramine Cardiovascular Outcomes Trial find?

PURPOSE OF REVIEW: Obesity continues to increase in prevalence in the USA and throughout the world. It is clearly a major contributor to morbidity and mortality. Unfortunately, effective prevention strategies are few. As a contributor to cardiovascular disease, obesity is an important treatment objective. However, before approval, all drugs must meet safety and efficacy concerns of the US Food and Drug Administration. RECENT FINDINGS: Since July 2010, the Food and Drug Administration's Endocrine and Metabolic Advisory Committee has reviewed three new drug applications and one previously approved drug for the treatment of obesity. This review examines in detail the Advisory Committee's consideration of the risk-benefit equation of the four drugs with a concentration on sibutramine and its key study, Sibutramine Cardiovascular Outcomes Trial. SUMMARY: Future development of drugs for the treatment of obesity will be dependent on whether they can survive review for safety and effectiveness. The Food and Drug Administration continues to be highly concerned with proposed obesity drugs increasing cardiovascular or any risks and may require changes to clinical research protocols.