An article from the Dec. 6 issue of the Journal of the American College of Cardiology takes a look the growing global obesity epidemic and the impact it has on heart health. Obesity adversely affects the majority of coronary heart disease risk factors and leads to complications with other cardiovascular disorders, such as heart failure, atrial fibrillation and risk for sudden cardiac death.
The study is one of the first to evaluate the impact of class III obesity (BMI ≥ 40 kg/m2) on care and outcomes in patients with ST-segment elevation myocardial infarction (STEMI). STEMI patients from the National Cardiovascular Data Registry (NCDR) ACTION Registry–GWTG were analyzed.
Although the class III obese group had less extensive coronary artery disease, better left ventricular systolic function and a lower incidence of smoking than the normal-weight group, the study found these patients had significantly higher in-hospital mortality rates. Additionally, extremely obese patients had a higher prevalence of hypertension and dyslipidemia and were close to three times as likely to have diabetes mellitus. Class III obese patients were found to present with STEMI more than 10 years earlier than their counterparts. African American women comprised 15.3 percent of the extreme obese group but only represented 6.2 percent of the normal-weight group.
The article comes on the heels of an announcement by the Centers for Medicare and Medicaid Services (CMS) that Medicare is adding coverage for preventive services to reduce obesity. According to CMS, more than 30 percent of both men and women in the Medicare population are estimated to be obese.
This decision adds to Medicare’s existing portfolio of preventive services that are now available without cost sharing under the Affordable Care Act and complements the Million Hearts initiative, of which the American College of Cardiology is a partner. Under the new benefit, screening for obesity and counseling for eligible beneficiaries by primary care providers in settings such as physicians’ offices are covered. For a beneficiary who screens positive for obesity with a body mass index (BMI) ≥ 30 kg/m2, the benefit would include one face-to-face counseling visit each week for one month and one face-to-face counseling visit every other week for an additional five months. The beneficiary may receive one face-to-face counseling visit every month for an additional six months (for a total of 12 months of counseling) if he or she has achieved a weight reduction of at least 6.6 pounds (or 3 kilograms) during the first six months of counseling.
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