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Published: Thursday, 7/29/2004

An advance in obesity war

MEDICARE'S inclusion of obesity as a disease in need of treatment is a two-edged sword. On the one hand, it offers help to hundreds of thousands of older Americans who want to lose weight. On the other, it implies that obesity is not only the government's business, but that responsibility also lies with each person.

The policy turnaround, which will make both invasive and non-invasive treatment methods available, is certainly welcome news for patients and doctors.

It should facilitate working together to combat the poor diets and lethargic physical habits that together lead to clogged arteries, slow hearts, taxed pancreases and gallbladders, and some cancers. These cause misery, cost lives, and run up medical bills.

Health and Human Services Secretary Tommy Thompson put the annual cost of treating obesity-related illnesses in the billions of dollars. The price of remedying obesity itself, and how it will be allocated, remains to be seen. Also unclear is whether the Medicaid program, which covers health costs for low-income people, will follow Medicare's lead. Private health programs are expected to.

Whatever happens in this regard, expect more emphasis on preventive health and more pressure on individuals to be partners with their physicians and insurers in their own well-being,

This is an approach that not only makes sense, but is fairer to all those footing the bills for these health programs.

The movement toward change will be slow, no surprise. Only in the fall will the Medicare agency review evidence on anti-obesity surgical procedures.

There are critics of the new policy who object to labeling as a disease a condition one can overcome by walking a few miles a day and by just saying no to food. Theirs is a point worth considering, if overeating did not seem an addiction of the sort that cigarette smoking is and soporific drugs and uppers can be. Addictions to these substances are diseases.

Doctors who manage anti-smoking programs say the greatest successes in cessation come with help. Chemicals may be part of it. The same for counseling. That some cannot stop "cold turkey" and stick to the necessary self-discipline is not a character flaw but the varied nature of addiction. Overeating has similar characteristics.

Too many Americans are bulging at the seams. Finding methods and regimens through which they make themselves healthier is desirable.

Medicare's fresh breakthrough will help make it happen.



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