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Obesity heavy subject

Bill will next be weighed in Appropriations

By Leigh E. Rich

The House Health and Human Services Committee has weighed in: Obesity is a health risk, physically and fiscally.

Though HHS members joked around a bit Monday while hearing House Majority Leader Alice Madden’s bill that would create a pilot project for Medicaid clients who are morbidly obese, they were serious about the verdict. House Bill 1066 passed 13 to 0 and now moves to Appropriations.

Madden, D-Boulder, wrapped up her comments after the committee listened to testimony from the public. “I know you have a full plate, so to speak,” she said, smiling while apologizing for the pun.

Even Rep. Debbie Stafford, R-Aurora, went on the record to express regret about having forgotten the Krispy Kremes. Apparently, she had promised the committee she’d spring for doughnuts when the bill was heard.

While the original bill required the Department of Health Care Policy and Financing to implement a widespread program to treat Medicaid patients who have a body mass index (BMI) equal to or greater than 30 as well as a co-morbidity related to obesity, Madden has since altered HB 1066 so that it would establish a two-year pilot program involving anywhere from 250 to 400 adults on Medicaid.

The rest of the bill remains the same and includes comprehensive treatment focusing on behavioral modification and the use of medications. Exact program details have yet to be established, since the state—if the bill passes—would contract with professionals to design and administer it. Treatment also would need to be tailored to the individuals chosen to participate, Madden explained at a press conference last week, and those in charge of the program would be required to report back to the health committee in 2007.

Despite the frivolity of the HHS committee as members settled in for another long haul with eight bills on the docket that day, the legislators all supported Madden’s initiative.

It would have been ill advised not to.

According to the Centers for Disease Control, about 64 percent of American adults are overweight, defined as having a BMI between 25 and 29.9, or obese, a BMI of 30 or greater. And approximately 16 percent of the nation’s children and adolescents are overweight, a number that’s doubled since the 1970s. (Medical professionals and researchers do not use the term “obese” in relation to children and adolescents.)

Every year, cardiologist Nelson Trujillo of the Colorado Medical Society told the committee, some 280,000 to 400,000 Americans die from weight-related illnesses.

“That’s a 747 every day,” he said, testifying that Madden’s bill, co-sponsored by Sen. Paula Sandoval, D-Denver, “is a start in a direction to control this disease and cure it.”

And it can be cured.

Obesity survivor Colista Lich is proof. She also spoke to the HHS representatives, displaying the pants she wore 15 months ago to add heft to her testimony.

Two of her could now fit into the one pair of jeans.

“I am the ‘after’ photo of this success story,” Lich said, explaining how she went from 320 pounds to 153 and from a BMI of 47.1 to 23.2.

At the press conference last week, Lich spoke in more detail about her plight.

“These were tight,” she admitted, holding up the jeans, “and I couldn’t walk up stairs.”

She also had Type II diabetes—a common illness related to being overweight or obese—knees and hips in need of replacement, and kidneys that were failing.

The kidneys were the final factor, Lich explained, in her decision to undergo gastric bypass surgery—something that won’t be offered in Madden’s pilot program, mainly because of the more than three-year waiting list in Colorado.

But Lich spoke to the HHS committee primarily about the “mental aspects” of treating obesity, saying she is encouraged by HB 1066 because the pilot program would address both the physical and psychological facets of treatment.

“You cannot divorce them,” she emphasized.

And for anyone who thinks she “took the easy way out, they’re wrong,” she said, adding that her success wouldn’t have been possible without changing her relationship with food and adhering to an exercise regimen.

“Eating is a high,” she testified, noting how we often use food “to forget, to cope, to remember or to celebrate.”

Madden acknowledged as much at last week’s press conference, reminiscing about one of her fondest childhood memories: “apple pie and ice cream.”

“It isn’t easy. I still have cravings,” Lich said, who empathized with other obese Coloradans “who may see themselves as broken and unfixable citizens.”

But obesity’s associated increased risks for diseases such as diabetes, hypertension, coronary heart disease, stroke, some types of cancer, sleep apnea and other respiratory problems, among others, are reversible, said Lich and several doctors who testified at Monday’s hearing.

Lich’s medical chart now reads “healthy 41-year-old female,” she said.

In addition to the life-threatening co-morbidities, obesity is costly as well—to the tune of $50 billion nationally in direct medical expenses every year, according to Trujillo, and $45 billion in indirect costs, such as absence from work.

Madden says that about 8,000 Medicaid patients in Colorado fall into the morbidly obese category, not including children, and estimates that her pilot program alone would offer the state “a conditional fiscal impact of almost $300,000 for the first year and almost $500,000 for the second year.”

“On the surface, this looks like a win-win program,” said Rep. Bill Berens, R-Broomfield, in support of the bill.

Even if it’s not 100 percent successful, as no program is, he added, “it appears a great deal of funds would be going back into the system.”

Only Rep. Kevin Lundberg, R-Berthoud, spoke out somewhat against the bill, primarily wondering why such a program would need to be under the auspices of the state.

Madden told Lundberg that such comprehensive weight-reduction programs have already proven successful in the private sector, both in terms of health outcomes and cost-benefits, and Barbara Prehmus of the Department of Health Care Policy and Financing said that, in the absence of a state-sponsored program, confidentiality would preclude providing the names of Medicaid clients who meet the program’s criteria.

“That seems to be a rather weak argument,” Lundberg said, adding that “there is a perverse side to Medicaid” preventing it from working “smoothly at all times.”

Regardless, Lundberg still cast a “yes” vote.

Because of the state’s current fiscal crunch, the obesity program would be funded with gifts, grants and donations or on a contingency basis, using some percentage of the back-end savings in medical costs to pay the program’s contractors.

Madden also said she is working with several manufacturers of weight-related medications to donate money or product.

And if it proves successful, Madden hopes this is something legislators will support in the long-term.

“The word ‘morbid’ has a meaning,” she said. 

Rich, L. E. (2005, February 11). Obesity heavy subject: Bill will next be weighed in Appropriations. The Colorado Statesman, pp. 1–2, 12.

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