Medicare announced late Tuesday that it would now allow coverage for obesity screening and counseling - services that were previously not covered. Sounds great, right? The problem with this is that the plan only allows reimbursement to physicians and nurses in a primary care setting - dietitians are not included.
As a registered dietitian, I am deeply saddened by this decision. Covering obesity counseling is certainly a step in the right direction, but since when do we ignore the professionals who have actually been extensively trained in the area? Registered dietitians go through a full degree program, complete an accredited internship and pass a national exam related to nutrition competencies.
While doctors are vitally important to our medical system, most do not have adequate training in nutritional issues. A study published in Academic Medicine in 2010 found that while most schools required "some form" of nutrition education, only 25 percent of medical schools required a dedicated nutrition course. The average medical student receives only 19.6 hours of nutrition instruction throughout a medical-school career.
That being said, there are always exceptions to the rule. There are doctors who specialize in obesity-related issues and pursue additional training in nutrition. Yet, why ignore dietitians who have pursued careers and training specifically in the field of nutrition?
Besides, doctors are already pressed for time with patients. Adding intensive nutritional counseling to their plates is likely an unrealistic expectation for many. We certainly don't want this to turn into a quick lecture about losing weight that gets billed as obesity counseling, followed by a patient not losing weight because they still do not understand how to make behavior changes. This gets viewed as a program failure and will ultimately undermine the entire concept of nutrition and fitness counseling.
I'm not saying that dietitians are the only people important to the fight against obesity. We certainly need many partners involved in this, both inside and outside of the medical realm. Doctors, dietitians, food manufacturers, city planning workers, government, school lunch programs, etc. - it will take a societal shift involving all these partners before we see major reductions in obesity rates. But at an individual nutrition counseling level, there is no doubt that dietitians need to be part of the solution.
Would you ask a physical therapist to put a cast on a broken leg? How about going to a speech therapist for psychological counseling? We need to support the appropriate officials if we want desired results. For intensive nutrition counseling, that means a registered dietitian.
Chrissy Carroll, MPH, RD, LDN
Inspired Wellness Solutions LLC
