Medicare Is Missing The Obesity Target

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On July 16, 2004 the headline posted all over America was "WASHINGTON (AP) -- Medicare now recognizes obesity as an illness, a change in policy that may allow millions of overweight Americans to make medical claims for treatments such as stomach surgery and diet programs." (

It was almost impossible to miss this story, since it was plastered on virtually every front page in the nation and received heavy rotation on all the major news networks.

The government representative in front of the cameras said all the right things about the dangers of excess body fat: Health and Human Services Secretary Tommy Thompson said, "Obesity is a critical public health problem in our country that causes millions of Americans to suffer unnecessary health problems and to die prematurely."

Treating obesity-related illnesses results in billions of dollars in health care costs, Thompson said.

"With this new policy, Medicare will be able to review scientific evidence in order to determine which interventions improve health outcomes for seniors and disabled Americans who are obese," Thompson told a Senate panel on Thursday. (end quote from

That is all 100% true and accurate; obesity DOES cause a multitude of health problems in the United States and around the world. Fitness professionals around the nation have joined together in congratulating the Department of Health & Human Services in finally taking a much more pro-active role in obesity prevention.

However, we must take issue with what appears to be the main focus of this new initiative: fat loss results through surgery. On July 21, 2004 the Idaho Press Tribune ( ran a much more in-depth story on this issue (written by Mark Sherman of The Associated Press). In part, this story stated that "Now willing to pay for a treatment that works, Medicare is shunning fad diets to focus on one of the more radical solutions, stomach bypass surgery. Despite the claims of various diets and surgical procedures, most researchers agree that no approach to weight reduction has been proven to be effective over the long haul.....officials said they would consider paying for something, but only something that can be shown to work."

We are shocked and dismayed that anyone at the Department of Health & Human Services would not automatically endorse and promote exercise as the number one proven remedy for obesity!

Please understand that we are not discounting the effectiveness of stomach bypass surgery. On the contrary, it is perhaps the best solution for some people. However, for the vast majority of Americans, regular cardiovascular and resistance exercise is will provide much better and long-lasting results.

Further along in the article from The Associated Press we find this quote: "Some health plans subsidize gym memberships, but it is unlikely that Medicare would, despite the undeniable benefits of exercise." The folks at Medicare just don't seem to get it. They're missing the obvious solution to obesity.

The plain and simple fact of the matter is that liposuction, stomach bypass surgery, and other surgical forms of obesity control do not convey the same benefits as exercise. That is an undisputed fact. Yes, fat-loss surgical procedures work for some people and have even saved lives. If you think you may be a candidate, then by all means please talk it over with your physician. Odds are good that your doctor will discuss it with you and then recommend (prescribe?) a healthier diet and regular exercise.

There are two basic reasons why exercise is superior to fat-loss surgery. First, the simple act of removing fat from your body does not make your heart healther (as exercise does). Surgically taking fat off your body (via liposuction) will also not prevent diabetes or hypertension (as exercise does). In short, although surgical procedures will make you healther they will not convey the same benefits as regular exercise.

The second reason that exercise is superior to surgical solutions is that we must change our behavior if we are to make life-long changes in our body composition. Think about it. What if we could magically take 20 lbs. of fat off our body today? Poof! It's gone. Now doesn't that feel (and look) good? What will happen if we don't change our diet or activity level....will that 20 lbs. come back? Of course! Similar to the yo-yo diets many of us have experienced, without permanent changes to our lifestyle and/or dietary habits, permanent change is next to impossible.

So, while we applaud the folks at Medicare for their added emphasis on obesity, we are alarmed that exercise will not (for the time being, at least) play a role in their new initiative. In the meantime, let's continue to work out regularly and try to keep our diets 'clean'. Let's talk to our doctors about our goals.....the odds are good that they'll continue to recommend regular exercise and a healthy diet.