There was a recent decision made regarding who Medicare and Medicaid will reimburse for providing behavioral weight loss counseling to obese individuals. This decision not only impacts me as a registered dietitian, but it impacts you as well.

Dr. Felicia Stoler is a registered dietitian, a nutrition and exercise physiologist, and journalist who runs a health consultancy in New Jersey. She is also the host of Honey, We're Killing the Kids on TLC and the author of Living Skinny in Fat Genes: The Healthy Way to Lose Weight and Feel Great.

We are both members of an American Dietitian Association discussion list and she has given me permission to share with you her take on this recent decision. What follows are the words of Dr. Stoler:

The Centers for Medicare and Medicaid Services (CMS) announced its decision to reimburse primary care physicians for Intensive Behavioral Counseling for Obesity (IBCO). It is a miracle that obesity is finally recognized as a disease. However, it is the kiss of death for interventions, because evidence-based practice has been ignored. The significance of this decision, and the ripple effect of those who have been part of the weight management care team PRIOR to CMS' decision, have been left out: Registered Dietitians (RDs), sychologists, Licensed Clinical Social Workers (LCSWs), community weight loss programs, and programs like Weight Watchers.

The current language has limited the treatment of those 65 and older with a BMI of 30 or greater with the least effective treatment option as their only "reimbursable" choice. According to CMS, "it is important that these preventative services be furnished in a coordinated approach as part of a comprehensive prevention plan within the context of a patient's comprehensive care. Primary care practitioners (PCPs) are characterized by their coordination of a patient's comprehensive healthcare needs."

We seldom see assistance from those in the primary care setting, with any "coordination of healthcare needs." Medicine has become a script pad with a drug or referral to a specialist - which is why so many people assume weight loss is as simple as taking a pill or looking for the quick fix. PCPs are supposed to be responsible for a patient's overall health care, but surely lack the training to be "one stop shopping" for their patients. This is the reason why there are specialties within healthcare. Ask any endocrinologist who is best at managing diabetes or a cardiologist about heart disease (and its precursors). In the mental health sphere, psychiatrists are the experts in pharmacological management of psychological disorders.

Here is the kicker, the PCP will be doing the billing, but who will be doing the IBCO? Will it be the physician, the nurse, or the physician's assistant? Perhaps a patient may watch a video and then Medicare is billed for it.

BMI as a measure of obesity is controversial. Technically anyone can plug their height and weight into a BMI calculator and see the results, free of charge, without a PCP billing Medicare for the same thing. As for "prevention" - by the time someone has a BMI of 30, there are a myriad of comorbidities that begin to emerge. Perhaps intervention should begin when BMIs are 26-29.99, because there is a greater chance of preventing diabetes, hypertension and high cholesterol.