Curbing Adult Obesity

The United States Preventive Services Task Force (USPSTF)¹ recently recommended screening and intervention for obesity. The USPSTF found good evidence that body-mass index (BMI) is a reliable and valid metric for identifying adults who are at risk for obesity-related morbidity and mortality (BMI, 30 kg/m2).

The task force also found good evidence that high-intensity counseling (more than one session monthly for at least three months) about diet and exercise along with behavioral interventions (skill development, motivation, and support strategies) can produce sustained weight loss (i.e., 3 to 5 kg reduction, maintained for a year or longer).

In addition, the task force noted that sibutramine and orlistat therapy can lead to sustained weight loss of the same magnitude and that, in those persons with BMIs of 40 or higher, gastric surgeries (i.e., banding) can lead to even greater weight loss.

Although the task force did not identify direct evidence of decreased morbidity or mortality related to these interventions, it noted effects on intermediate outcomes, such as lipid levels, that would be expected to affect long-term rates of weight-related morbidity and mortality.

Horizon NJ Health encourages our physicians to screen members for obesity and recommend interventions when indicated. A BMI calculator from the National Heart, Lung, and Blood Institute is available at http://www.nhlbisupport.com/bmi.

As part of Horizon NJ Health's commitment to enhancing the quality of health for our members, antiobesity agents (Xenical and Meridia) are covered through Horizon NJ Health's clinical prior-authorization program. Pharmacy representatives, in consultation with Horizon NJ Health's Medical Directors, determine medical necessity consistent with clinical pharmacy policy.

To make this determination, clinical information is needed from the prescribing physician.

• For the initial request of an antiobesity agent, physicians need to supply the member's current height, weight, and any comorbid medical conditions.
• Information on the member's dietary status and whether the member is enrolled in support programs will be needed.
• For follow-up requests, we require the member's recent weight.

The Horizon NJ Health Pharmacy Department can be reached at 1-800-682-9094 for all prior-authorization requests. Pharmacy Department office hours are Monday through Friday, between 8:00 a.m. and 7:00 p.m. A pharmacist is available 24 hours a day, seven days a week.

Reference:
¹ United States Preventive Services Task Force. "Screening for Obesity in Adults." http://www.ahcpr.gov/clinic/uspstf/uspsobes.htm