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Posted 7/1/2020

Prepared by Christopher Gallagher, OCC Washington Representative

38 House TROA Cosponsors Highlight Obesity/COVID Link

On June 22nd, Representatives Hastings (D-FL), Holding (R-NC), Watson- Coleman (D-NJ) and Roe (R-TN) were joined by 34 other House cosponsors of HR 1530, the Treat and Reduce Obesity Act (TROA) in sending a letter to House leadership regarding the impact of COVID-19 on those affected by obesity —- specifically asking for Congress to include TROA in the next pandemic relief package.

The letter echos the points made by House TROA champions in their May 8th letter Speaker Pelosi (D-CA) and Minority Leader McCarthy (R-CA) — highlighting how obesity has been a significant contributor to negative outcomes in previous viral outbreaks and will likely be so in future ones given the numerous comorbidities, reduction in respiratory volume, and inflammation associated with obesity. The 38 House members also discussed how this crisis has magnified the health inequities experienced by racial and ethnic minority communities, which are prone to be more affected by obesity.

Obesity Care Continuum (OCC) groups sent their own letter to House leadership on May 15th — echoing support for including TROA in the next COVID relief package.

OCAN Comments on USPSTF Cardiovascular Recommendations

On June 8th, the Obesity Care Advocacy Network (OCAN) submitted comments regarding the U.S. Preventive Services Task Force (USPSTF) Draft Recommendation Statement: Healthy Diet and Physical Activity to Prevent Cardiovascular Disease in Adults with Risk Factors: Behavioral Counseling Interventions.

In general OCAN noted that “compared to the earlier recommendation, this recommendation statement provides better clarity on the population to which it applies and how it overlaps with the healthy lifestyle behavioral counseling recommendations for abnormal blood glucose, obesity, and CVD risk reduction for those with lower risk. Also, by using the terms “behavioral counseling” and “behavioral counseling interventions,” the USPSTF is moving toward terminology more consistent with that used in other similar recommendation statements. In addition, this draft recommendation statement makes it clearer that evidence supports delivery of the service by lifestyle coaches and trained leaders.”

Also, OCAN noted how “it is vital that USPSTF highlight and repeatedly note both the efficacy of behavioral counseling for healthy lifestyle AND that it is widely accessible, available and affordable, because, as the draft evidence review noted, clinicians are providing or referring this recommended preventive service very infrequently. We must increase referral and provision rates of behavioral counseling for healthy lifestyle to increase the health status of our nation."

OCAN Comments on HELP Committee Pandemic White Paper

On June 26th, OCAN submitted comments to Senate HELP Committee Chair Lamar Alexander (R-TN) regarding his White Paper on Preparing for the Next Pandemic. In its comments OCAN “urged the Committee to take steps to ensure that this pandemic, as well as the next one, do not disproportionately impact the nearly 40% of Americans that are affected by obesity. In light of evidence of poorer outcomes experienced by patients with obesity that contract COVID-19, as well as the ongoing challenges that obesity presents for the health care system, updating both public and private coverage policies to support the treatment of obesity should be part of a comprehensive response to COVID-19 and preparation for the next pandemic.”

OAC Comments on ICER Draft Evidence Report Surrounding NASH

On June 24th, OCC member group the Obesity Action Coalition submitted comments regarding the Institute for Clinical and Economic Review (ICER) draft evidence report entitled “Obeticholic Acid for the Treatment of Nonalcoholic Steatohepatitis (NASH) with Fibrosis.”

OAC highlighted how “Liver health can sometimes be overlooked in people with obesity, where cardiovascular and endocrinological complications take priority. However, the prevalence of nonalcoholic fatty liver disease (NAFLD) is higher in people with obesity compared with the general population, and up to one quarter of people affected by obesity with NAFLD go on to develop NASH. Obesity can also exacerbate genetic predisposition to fatty liver and fibrosis, increasing the risk of developing cirrhosis.”

OAC also discussed that “while treating an individual’s obesity can provide beneficial outcomes for those with NAFLD, ICER’s modeling should not assume that obesity care and weight loss treatments are covered services under most health insurance plans and that such services are widely available. The unfortunate reality is that coverage for counseling, medications and surgery for obesity is either outright excluded or dramatically limited due to discriminatory benefit design and providers may not provide such services due to such coverage issues. Patients often face arbitrary hurdles to care such as waiting periods, higher copays and separate deductibles that increase their share of the treatment cost or discourage utilization.

Finally, OAC expressed disappointment regarding the lack of patient inclusive or people-first language throughout the report and called on ICER to put patients at the center of all of their assessments, and this should be abundantly clear in their choice of language throughout the report.

OCC Updates its Statement on Patient Access to Care Issues Surrounding Obesity and COVID-19

During June, OCC member groups updated their statement regarding “Patient Access to Care Issues Surrounding Obesity and COVID-19.” In the statement, OCC highlighted how “COVID-19 is disrupting the normal life of many Americans and throughout the world, especially individuals with obesity and its related health complications that often put them at higher risk. A growing body of literature demonstrates a direct link between obesity and poor outcomes from the COVID-19 virus. Data from New York City indicates that people with both COVID-19 and obesity are two times more likely to be admitted to the hospital, and people with severe obesity are 3.6 times more likely to require critical care, such as mechanical ventilation. Our country must acknowledge obesity for the chronic disease that it is and take steps to treat it in the same serious fashion as others such as diabetes and hypertension.”

The statement continues that “while there are evidence-based treatments for people with obesity that mitigate the impacts of the disease and improve health outcomes, the present landscape of obesity care coverage remains piecemeal and laden with arbitrary hurdles to comprehensive care. As a nation we must move to eliminate these random and unscientific barriers to care – both for the long term and immediate health of those affected by obesity!” OCC will be sharing the statement with every State Governor and Insurance Commissioner to highlight a number of areas of obesity care and health plan coverage practices that OCC believes should be reevaluated both during, and beyond the COVID-19 public health crisis.

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