Latest news with #HarvardTHChan
Forbes
4 days ago
- Health
- Forbes
Coverage Of Weight Loss Drugs By Medicaid Plans Continues To Lag
California recently passed a budget for 2025-2026 that eliminates Medicaid coverage for GLP-1 agonists for weight loss. Other states are considering similar cuts. States are struggling to close gaps in budgets. Enactment of The Big Beautiful Bill will likely add pressure on budget finances. It's hard to envision a scenario in which state Medicaid agencies expand coverage of weight loss treatments in the short term. About 40% of adult Americans are considered obese. Rates of obesity have been steadily on the rise since 1980. The Harvard T.H. Chan School of Public Health reminds us that obesity increases the risk of developing conditions such as diabetes, heart disease, osteoarthritis and several cancers. Medications known as glucagon-like peptide-1 agonists, or GLP-1s, have become very popular as weight loss agents. Taken in accordance with the instructions on the label and an appropriate diet and exercise regimen, GLP-1s are effective at lowering a person's weight. However, payers in both the commercial and public sectors often balk at coverage. Commercial insurance coverage is improving but still isn't universal by any means, whether in the employer-sponsored segment or individual market. In the federal insurance program for the elderly and some disabled persons, Medicare, coverage of GLP-1s for weight loss alone is prohibited, though obese patients can get the semaglutide-based product, Wegovy, covered for heart disease. Medicaid, a federal-state partnership that provides health coverage for low-resourced people, generally doesn't reimburse GLP-1s for obesity. Only 14 states cover obesity medications in their state Medicaid plans. And like California, other states have proposed cutting coverage for obesity medications or have already done so, whether in the Medicaid program itself or state employee plans. For example, North Carolina and West Virginia have recently eliminated coverage of GLP-1s for weight loss for state employees due to cost concerns. With significant Medicaid cuts in federal budget outlays as a result of passage of The Big Beautiful Bill, it is likely more states will follow suit. The law severely restricts how states pay for their share of Medicaid costs. To illustrate, states have long used healthcare provider taxes and certain special payment arrangements to fund their portion of the program. Yet the new legislation limits these financing tools, effectively shifting hundreds of billions in costs to state budgets. States that do opt to cover various weight loss treatments, including medications, nutrition programs and bariatric surgery, almost invariably deploy restrictive eligibility requirements around things like body mass indices and the presence of co-morbidities, along with the use of prior authorization and step edits. This means, for instance, that individuals wanting to access treatments must attest to 'increased exercise activity' and submit documentation proving that they've tried and failed to lose weight after receiving nutrition counseling and going on a strict, low-calorie diet. In light of budget constraints, steep cuts to a wide range of Medicaid benefits are probable in the short term. This may come in the form of even more severe limits on coverage of medicines and other healthcare technologies, including obesity treatments. It's possible that through a voluntary demonstration project that the Centers for Medicare and Medicaid Services announced last month, some state Medicaid agencies could soon elect to cover these drugs for 'weight management.' But the plan has not been finalized. Nor have any details been divulged besides the fact that it would commence in April of next year for Medicaid. Without information on how state programs would be incentivized to sign up, it's unclear who would be interested. The perennial issue for all types of payers is money. Once these therapeutics are covered by insurance, they tend to blow up budgets. Many payers in the commercial sector cite serious budgetary concerns. A survey released this spring of employer-based plans shows that GLP-1 drugs used for obesity account for an average of 10.5% of total annual claims. And if Medicare were to lift its prohibition on coverage, it would cost the program a cumulative $35 billion from 2026-2034. While the estimates included possible savings from improved health, these were not nearly sufficient to offset the costs of the medications. Such projected expenses haven't been calculated specifically for Medicaid. But the churn or enrollee turnover is so high in Medicaid that any longer-term, downstream cost savings would be very hard to come by, further exacerbating the budgetary problem. While cost is a primary consideration for payers, lack of persistence on GLP-1s is another reason for hesitance to reimburse weight loss drugs. Patients who are treated with GLP-1s tend to discontinue at a relatively high rate. One study cited by federal government policymakers found that approximately 53% of patients with overweight or obesity taking semaglutide-based products didn't persist on treatment past two months. Starting and stopping on these medicines so soon yields little or no benefit to patients and only adds costs for payers. It's possible that employers, commercial insurers and payers in the public sector—including Medicaid—decide to eventually revisit their coverage decisions if net prices of GLP-1s decrease sufficiently, combined with more data showing the benefits of weight loss drugs when taken consistently and persistently in conjunction with an appropriate dietary and exercise regimen. Until that time, however, coverage will continue to be a major hurdle.
Washington Post
21-07-2025
- Health
- Washington Post
5 misunderstood foods and how to spot nutrition myths
Consumer Reports has no financial relationship with any advertisers on this site. When it comes to eating well, making good choices has probably never been quite as confusing as it is right now. 'It's a Wild West out there in terms of health misinformation,' says Walter Willett, a professor of epidemiology and nutrition at the Harvard T.H. Chan School of Public Health. 'Anybody can claim to be a nutrition expert, but they are not always reliable sources.'
The Independent
30-06-2025
- Health
- The Independent
Can intermittent fasting help you lose weight?
Obesity affects two in five U.S. adults, contributing to nearly $173 billion in annual healthcare costs and increasing risks of chronic conditions. A new study published in The BMJ, involving researchers from Harvard T.H. Chan School of Public Health, analyzed the effectiveness of various intermittent fasting strategies. The research found that alternate-day fasting, which involves fasting for a full day every other day, was the most effective form of intermittent fasting for weight management. Alternate-day fasting led to 2.8 pounds greater weight loss compared to traditional calorie-restricted diets and improved cardiometabolic risk factors such as waist circumference and cholesterol levels. Despite its benefits, the study noted that the observed weight loss did not meet the minimally important clinical threshold, and individuals should consult healthcare providers before adopting intermittent fasting.
Yahoo
29-06-2025
- Health
- Yahoo
BMI is B-A-D, a new study suggests. Here's a better way to measure weight
When it comes to measuring weight, BMI is the acronym everyone loves to hate. Health professionals have long used body mass index as a quick screening tool to fast-track certain patients into a 'code red' management plan — people whose weight puts them in danger of future health problems. The issue is that BMI measures health risk by calculating height and weight. However, muscle and bone weigh more than fat, so BMI measurements can overestimate the danger for people with a muscular build or a larger frame. Conversely, BMI can underestimate health concerns in older adults and anyone who has lost muscle, according to the Harvard T.H. Chan School of Public Health in Boston. Now, authors of a new study say a different approach to weight measurement may be a more accurate way to predict future health issues. Bioelectrical impedance analysis, or BIA, uses undetectable electric currents to measure not only the percentage of body fat but also lean muscle mass and water weight. The technology works like this: You stand on metal plates on the machine while holding your hands or thumbs on another metal attachment held away from the body. Once started, the machine sends a weak electrical current through the body. Body fat, muscle and bone all have different electrical conductivity, so the machine uses algorithms to determine lean muscle mass, body fat percentage and water weight. 'We found body-fat percentage to be a stronger predictor of 15-year mortality risk in adults between the ages of 20 and 49 than BMI,' said Arch Mainous III, lead author of the study published Tuesday in the journal Annals of Family Medicine. When it came to deaths from heart disease, people with high body fat as measured by BIA were 262% times more likely to die than people who had a healthy percentage of body fat, said Mainous, a professor and vice chair of research in community health and family medicine at the University of Florida School of Medicine. 'Now remember, using BMI did not flag any risk at all in this younger population, which isn't one we typically consider to be at high risk for heart disease,' said senior author Dr. Frank Orlando, a clinical associate professor of community health and family medicine at University of Florida Health. 'Think of the interventions we can do to keep them healthy when we know this early. I think it's a game-changer for how we should look at body composition,' Orlando said. BMI is measured by dividing your weight by the square of your height. (If you are mathematically challenged like I am, the National Institutes of Health has a free calculator.) In BMI world, a body mass between 18.5 and 24.9 is a healthy weight, between 25 and 29.9 is overweight, between 30 and 34.9 is obese, between 35 and 39.9 is class 2 obesity, and anything greater than 40 is 'severe' or class 3 obesity. People are considered underweight if their BMI is lower than 18.5. Using BMI to measure health risk works — on a population level. Countless studies have shown that a greater BMI really does correlate with developing chronic diseases of all kinds — cancer, heart disease, type 2 diabetes, kidney and liver disease, and more. Where BMI fails is at the patient level. Imagine a patient who is 'skinny fat' — thin on the outside but riddled with globs of fat wrapped around major organs on the inside. Your BMI would be fine even though your health was at risk. 'Those people are more likely to have nonalcoholic fatty liver disease, more likely to have elevated glucose, more likely to have elevated blood pressure, and more likely to have inflammation in general,' Mainous said. All of these health issues can be treated, stopped and in some cases even reversed if caught early enough, he added. While doctors are aware of the issues with BMI, many prefer it 'because it is cheap and easily put into practice,' Mainous said. 'They'd like to use a more direct measurement such as a DEXA scan, but those cost too much and are not widely available, so everyone falls back to the indirect measure of BMI.' DEXA stands for dual-energy X-ray absorptiometry and is the gold standard for body mass analysis. Such machines can cost between $45,000 and $80,000, so patients typically travel to a hospital or specialty center to get the scan, Orlando said. The cost to the patient can easily be $400 to $500 per scan, he said. 'However, we found the newer versions of bioelectrical impedance are pretty accurate, giving some valid and reliable results,' Orlando said. One note — at-home based bioelectrical impedance products are not nearly as accurate, said Dr. Andrew Freeman, director of cardiovascular prevention and wellness at National Jewish Health in Denver. 'They can be affected a lot by how much body fluid you have, how hydrated you are,' said Freeman, who was not involved with the new research. 'At-home measurements will only give a ballpark — the clinic-based machines are more precise.' The new study analyzed data on 4,252 men and women who participated in the 1999 to 2004 federal survey called NHANES, or the National Health and Nutrition Examination Survey, a yearly checkup of the nation's health. Technicians measured each person's body composition, including height, weight and waist circumference. In addition, all participants underwent a clinic-based bioelectrical impedance analysis, which measures the body's resistance to electrical currents. Researchers then compared that data with the National Death Index through 2019 to see how many people died. After adjusting for age, race and poverty status, the study found a BMI that labeled someone as obese was not associated with a statistically significant higher risk of death from any cause, when compared with those in healthy BMI range. People with high body fat as measured by bioimpedance analysis, however, were 78% more likely to die from any cause, Mainous said. Measuring waist circumference was also helpful, but not as accurate as body mass. Add that to the 262% higher chance of dying from heart disease found by the study, and it's a no-brainer for doctors to use bioelectrical impedance analysis on patients, Orlando said. 'Let's face it, the magnitude of risk this study shows is enormous,' Freeman said. 'It's scary to think that we may have been using a surrogate — BMI — that may not have been all that accurate over the years.' The study shows how better weight measurements could easily become personalized medicine, Freeman added. 'Imagine you came into your doctor's office,' he said. 'They provided your body fat percentage and an individualized risk assessment. They talked to you about exercise and other lifestyle changes and referred you to a nutritionist. 'They gave you an opportunity to make these changes, and then if needed, helped you out with medication. If the medical profession did this and were able to save many more lives, that would be amazing.' Get inspired by a weekly roundup on living well, made simple. Sign up for CNN's Life, But Better newsletter for information and tools designed to improve your well-being.
CNN
24-06-2025
- Health
- CNN
BMI is BAD, a new study suggests. Here's a better way to measure weight
When it comes to measuring weight, BMI is the acronym everyone loves to hate. Health professionals have long used body mass index as a quick screening tool to fast-track certain patients into a 'code red' management plan — people whose weight puts them in danger of future health problems. The issue is that BMI measures health risk by calculating height and weight. However, muscle and bone weigh more than fat, so BMI measurements can overestimate the danger for people with a muscular build or a larger frame. Conversely, BMI can underestimate health concerns in older adults and anyone who has lost muscle, according to the Harvard T.H. Chan School of Public Health in Boston. Now, authors of a new study say a different approach to weight measurement may be a more accurate way to predict future health issues. Bioelectrical impedance analysis, or BIA, uses undetectable electric currents to measure not only the percentage of body fat but also lean muscle mass and water weight. The technology works like this: You stand on metal plates on the machine while holding your hands or thumbs on another metal attachment held away from the body. Once started, the machine sends a weak electrical current through the body. Body fat, muscle and bone all have different electrical conductivity, so the machine uses algorithms to determine lean muscle mass, body fat percentage and water weight. 'We found body-fat percentage to be a stronger predictor of 15-year mortality risk in adults between the ages of 20 and 49 than BMI,' said Arch Mainous III, lead author of the study published Tuesday in the journal Annals of Family Medicine. When it came to deaths from heart disease, people with high body fat as measured by BIA were 262% times more likely to die than people who had a healthy percentage of body fat, said Mainous, a professor and vice chair of research in community health and family medicine at the University of Florida School of Medicine. 'Now remember, using BMI did not flag any risk at all in this younger population, which isn't one we typically consider to be at high risk for heart disease,' said senior author Dr. Frank Orlando, a clinical associate professor of community health and family medicine at University of Florida Health. 'Think of the interventions we can do to keep them healthy when we know this early. I think it's a game-changer for how we should look at body composition,' Orlando said. BMI is measured by dividing your weight by the square of your height. (If you are mathematically challenged like I am, the National Institutes of Health has a free calculator.) In BMI world, a body mass between 18.5 and 24.9 is a healthy weight, between 25 and 29.9 is overweight, between 30 and 34.9 is obese, between 35 and 39.9 is class 2 obesity, and anything greater than 40 is 'severe' or class 3 obesity. People are considered underweight if their BMI is lower than 18.5. Using BMI to measure health risk works — on a population level. Countless studies have shown that a greater BMI really does correlate with developing chronic diseases of all kinds — cancer, heart disease, type 2 diabetes, kidney and liver disease, and more. Where BMI fails is at the patient level. Imagine a patient who is 'skinny fat' — thin on the outside but riddled with globs of fat wrapped around major organs on the inside. Your BMI would be fine even though your health was at risk. 'Those people are more likely to have nonalcoholic fatty liver disease, more likely to have elevated glucose, more likely to have elevated blood pressure, and more likely to have inflammation in general,' Mainous said. All of these health issues can be treated, stopped and in some cases even reversed if caught early enough, he added. While doctors are aware of the issues with BMI, many prefer it 'because it is cheap and easily put into practice,' Mainous said. 'They'd like to use a more direct measurement such as a DEXA scan, but those cost too much and are not widely available, so everyone falls back to the indirect measure of BMI.' DEXA stands for dual-energy X-ray absorptiometry and is the gold standard for body mass analysis. Such machines can cost between $45,000 and $80,000, so patients typically travel to a hospital or specialty center to get the scan, Orlando said. The cost to the patient can easily be $400 to $500 per scan, he said. 'However, we found the newer versions of bioelectrical impedance are pretty accurate, giving some valid and reliable results,' Orlando said. One note — at-home based bioelectrical impedance products are not nearly as accurate, said Dr. Andrew Freeman, director of cardiovascular prevention and wellness at National Jewish Health in Denver. 'They can be affected a lot by how much body fluid you have, how hydrated you are,' said Freeman, who was not involved with the new research. 'At-home measurements will only give a ballpark — the clinic-based machines are more precise.' The new study analyzed data on 4,252 men and women who participated in the 1999 to 2004 federal survey called NHANES, or the National Health and Nutrition Examination Survey, a yearly checkup of the nation's health. Technicians measured each person's body composition, including height, weight and waist circumference. In addition, all participants underwent a clinic-based bioelectrical impedance analysis, which measures the body's resistance to electrical currents. Researchers then compared that data with the National Death Index through 2019 to see how many people died. After adjusting for age, race and poverty status, the study found a BMI that labeled someone as obese was not associated with a statistically significant higher risk of death from any cause, when compared with those in healthy BMI range. People with high body fat as measured by bioimpedance analysis, however, were 78% more likely to die from any cause, Mainous said. Measuring waist circumference was also helpful, but not as accurate as body mass. Add that to the 262% higher chance of dying from heart disease found by the study, and it's a no-brainer for doctors to use bioelectrical impedance analysis on patients, Orlando said. 'Let's face it, the magnitude of risk this study shows is enormous,' Freeman said. 'It's scary to think that we may have been using a surrogate — BMI — that may not have been all that accurate over the years.' The study shows how better weight measurements could easily become personalized medicine, Freeman added. 'Imagine you came into your doctor's office,' he said. 'They provided your body fat percentage and an individualized risk assessment. They talked to you about exercise and other lifestyle changes and referred you to a nutritionist. 'They gave you an opportunity to make these changes, and then if needed, helped you out with medication. If the medical profession did this and were able to save many more lives, that would be amazing.'
