The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #64824

Roy Grant¹, Pamella Darby, MPH, RD², Alan Shapiro, MD³, and Irwin Redlener, MD². (1) The Children's Health Fund, 317 East 64th Street, New York, NY 10021, 212-535-9400, rgrant@chfund.org, (2) Division of Community Pediatrics, The Children's Hospital at Montefiore, 317 East 64th Street, New York, NY 10021, (3) South Bronx Health Center for Children and Families, The Children's Hospital at Montefiore, 871 Prospect Avenue, Bronx, NY 10459

National data show that 64% of adults – nearly two-thirds - are overweight (Body Mass Index, BMI, >25); and 31% are obese (BMI >30). An estimated 47 million American adults show signs of “metabolic syndrome” (insulin resistance, elevated blood sugar and triglycerides, high cholesterol, and hypertension) and are at risk of type 2 diabetes. Prevalence rates are higher for racial-ethnic minority groups and those with less than a high school education. This “pandemic” is a public health crisis. It is estimated that the health care cost for an individual diagnosed with diabetes is 380% higher than for those not so diagnosed. Increasingly the consequences of poor nutrition and inactivity are pediatric problems, especially affecting poor and minority youth. Despite these trends, and efforts at the federal level to call attention to them (e.g., the 2001 Surgeon General report), there are significant obstacles in the health care finance system to prevention and early identification. This presentation focuses on reimbursement issues – e.g., making “overweight” or “obesity” billing diagnoses that can be used to ensure that primary care visits and nutrition counseling are covered by insurance or Medicaid. An advocacy strategy to improve our current counterproductive situation is discussed, focusing on reimbursement for services to prevent obesity, monitor weight, and prevent secondary conditions like diabetes and hypertension. Currently, interventions for overweight and obesity cannot be reimbursed until they are considered secondary to preventable chronic conditions like diabetes or hypertension. Implications for managed care networks will be discussed.

Learning Objectives:

• At the end of the session, participants will be able to state financial obstacles to obesity prevention and treatment; At the end of the session, participants will be able to list advocacy strategies that may be implemented in their community.

Keywords: Policy/Policy Development, Obesity

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.