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Critically appraise the healthcare policy using Bardach’s eightfold steps to policy analysis.

The healthcare policy I will be critically appraising using Bardach’s eightfold steps is the Treat and Reduce Obesity Act (TROA) of 2023.

Define the problem.

Obesity is a healthcare issue for all age groups (Gadde et al., 2018). Obesity creates many avoidable health problems. Obstructive sleep apnea, hypertension, non-insulin-dependent diabetes mellitus, and osteoarthritis are examples of comorbid conditions that can be related to obesity (Centers for Disease Control and Prevention [CDC], 2022). Decreasing the rates of obesity is a strategy to reduce the comorbid and metabolic conditions associated with obesity and must be addressed at the legislative level. The need to establish solutions addressing this issue is crucial.

Assemble evidence.

The World Health Organization (WHO) reports worldwide prevalence of obesity has tripled in the last forty-six years. Over 1.9 billion, or 39% of adults aged eighteen or older, were overweight. Of these, over 650 million, or 13%, were obese (World Health Organization [WHO], 2022). The most recent data shows obesity prevalence from 2017-2020, as 41.8% of adults aged 20 years and over suffered from obesity in the United States (U.S.). This number is up from 2013-2016, when the number was 38.6%. Obesity in the U.S. is getting worse (Healthy People 2030, 2020).

Develop alternatives.

Passing the bill into law would create a pathway to evidence-based medical treatments for Americans suffering from obesity. Currently, under the existing law, obesity services are elective. This makes access to care issues for people seeking medical treatment for obesity. The alternative to passing TROA will let the obesity rates in the U.S. rise, causing an unnecessary increase in comorbid and metabolic conditions.

Select criteria to evaluate the alternatives.

The advantage of passing TROA is that it will expand obesity services to include intensive behavioral lifestyle therapy to be covered under Medicare policies. It will also provide coverage for injectable obesity medications (Treat and Reduce Obesity Act [TROA], 2023). The disadvantage of passing TROA will be that closing the gap in care at the physician’s offices will be difficult due to the under-representation of licensed healthcare clinicians in the country who are needed to treat and provide lifestyle change therapy for persons suffering from obesity. The return on investment (ROI) for passing the TROA is reducing the country’s rising obesity rates. Decreasing the rates of obesity is a strategy to minimize comorbid and metabolic conditions.  The direct and indirect cost of obesity in the U.S. was more than $427,800,000,000 in 2014 (TROA, 2023).

Project outcomes

Ward et al. (2019) report that by 2030, nearly one in two adults in the U.S. will have obesity, with a prevalence higher than 50% in 29 states and not below 35% in any one state (Ward et al., 2019). The prevalence of obesity in the U.S. will continue to rise without the passage of TROA. Already skyrocketing healthcare costs will continue to increase for patients suffering from obesity. Offering lifestyle therapy and injectable medications to people suffering from obesity will improve patient outcomes using a multidisciplinary, evidence-based practice model. This model will focus on the prevention and early identification of obesity (Ward et al., 2019).

Analyze trade-offs.

The decision to pass TROA is the ability to deliver evidence-based treatment plans to an epidemic in motion. The decision not to pass TROA will allow the obesity prevalence projections cited by Ward (2019) to become a reality and cause an inability to treat the comorbid and metabolic conditions of obesity successfully.  

Make decisions.

Expanding the reach of obesity treatment through the passage of TROA can provide a pathway to determining solutions to this health crisis. Current practice in the healthcare system needs to be more sustainable and has created a gap in practice (Gadde et al., 2018). Practical interventions must be offered to U.S. citizens to underpin safe and effective ways to address, treat and eventually cure obesity.

Communicate results.

A comprehensive approach to treating obesity will start with the passage of TROA. A health policy that addresses obesity prevention and treatment will improve health outcomes. Expanding weight management care to all U.S. citizens through TROA will help ease the burden of obesity through health policy.

References

Centers for Disease Control and Prevention. (2022). About adult BMI. https://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/index.html

Gadde, K., Martin, C. K., Hans-Rudolf, B., Heymsfield, S. B. (2018). Obesity: Pathophysiology and management. Journal of the American College of Cardiology, 71(1), pages 69-84. https://doi.org/10.1016/j.jacc.2017.11.011

Healthy People 2030. (2020). https://health.gov/healthypeople/objective-and-data/browse-objectives/overweight-and-obesity/reduce-propertion-adults-obesity-nws-03

Hales, C. M., Carroll, M. D., Fryar, C. D., & Ogden, C. L. (2020). Prevalence of obesity and severe obesity among adults: United States, 2017–2018. National Center for Health Statistics Data Brief 360. Centers for Disease Control and Prevention. www.cdc.gov/nchs/products/databriefs/db360.htm

Treat and Reduce Obesity Act, 118thCongress, 1st session. (2023). https://www.carper.senate.gov/wp-content/uploads/TROA-Bill.pdf

Ward, Z., Bleich, S. N., Cradock, A. L., Barrett, J. L., Giles, C. M., Flax, C., Long, M. W., & Gortmaker, S. L. (2019). Projected U.S. state-level prevalence of adult obesity and severe obesity. The New England Journal of Medicine, 381(25), 2440–2450. https://doi.org/10.1056/NEJMsa1909301

World Health Organization. (2022). Obesity and overweight. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight