The Affordable Health Care Act vs Childhood Obesity: Good Intentions Running Amok

This morning I read an article in the NYT that actually made me feel sorry for health insurance companies and wonder just how affordable the Affordable Heath Care Act will be.  The article was entitled “Learning to be lean.  With few proven models, health sector takes on childhood obesity,” and was written by Reed Abelson.  Apparently, the new federal health care law, among its many provisions, requires both health insurers and employers to pay the cost of screening children for obesity and providing them with appropriate counseling.  This has health insurers scrambling to find what just what appropriate counseling might be.

I don’t need to remind any of my readers that childhood obesity is a big (no pun intended) problem; about 30% of children are considered overweight (the politically correct terms are “at risk for overweight” and “overweight.”  Please don’t ever call a child obese.  Anyway, there are considerable data in the scientific literature to show that childhood obesity is a risk factor for adult obesity and its many health problems.  So, screening for overweight or whatever we want to call it is appropriate as is conveying the information to parents.  This task is not terribly complicated or costly- just a quick height and weight measurement, calculation of a BMI, and information about what the data mean.  This information should be part of any well child medical care visit and the information can also be provided to parents through the schools, something already done in many places.  So far so good.  But what about “appropriate counseling” for those children found to be overweight?  As the NYT article notes, there are few if any proven models (how about no proven models with good long-term success?) to chart a way forward for insurers and employers.  So, is the U.S. health care system (to the extent we have a system) now taking the tack of requiring health insurers and employers to do the research and determine what constitutes appropriate counseling? It’s sort of like requiring insurers to screen for cancer and when a diagnosis is made, to do the research to find the most effective therapy.   In my opinion this is not health care reform at its best.  We should not identify health care problems such as childhood obesity and then require action that is very likely to be time and money poorly spent.  Good intentions do not justify unproven interventions.

I do not want to seem like a total grinch about this subject.  I like many provisions in the Affordable Health Care Act and I  would recommend that we screen children for weight status along with other health measures and require that health care providers offer nutritional counseling  (covered by the health insurer) on an annual basis, much like Medicare already does for people with diabetes mellitus.  That would be a reasonable start and one that might make the Affordable Health Care Act more affordable than the road we seem to be going down.  We must not outpace the science with our desire to do all that is possible in an effort to make our children healthy.

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