Should States Pay for Nutritional Counseling?

vegetablesYesterday, and NPR story covered the fact that Tennessee’s Medicaid program, TennCare, will pay for obese patients to have bariatric surgery, but not for counseling from a dietitian. “That has led some critics to complain that TennCare won’t pay for an ounce of prevention but will pay for a pound of cure,” writes Daniel Potter.

Wendy Long, the chief medical officer of TennCare says that bariatric surgery is the most cost-effective method for the state to treat obesity. Gastric bypass surgery costs the state about $20,000 per operation.

One dietitian, Sarah-Jane Bedwell, says that this practice isn’t a real solution to the problem. “It’s like saying we’re going to fill your cavities, but we’re not going to ever pay for you to get your teeth cleaned or teach you how to brush your teeth,” she contends.

Bedwell argues that her services, which go for $75.00 per hour, would save the Tennessee money in the long run. But Long disagrees: “there’s really no evidence to support the fact that providing those services would result in a decrease in medical cost, certainly not immediately, and even in the longer term.” She further argues that patients can get nutritional counseling from their doctors. Another doctor is quoted saying that almost no method other than surgery consistently helps obese people keep weight off once it is lost.

Tell us what you think! Dietitians can provide invaluable information to their clients, but would a state-supported nutritional counseling really lead people to make fundamental lifestyle changes?

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