Medicare has announced that, in an effort to promote the prevention of type 2 diabetes through lifestyle changes in exercise and diet leading to weight loss, it is launching its new evidence-based Medicare Diabetes Prevention Program (MDPP) that will be covered under Medicare Part B.

Curious about the specifics of the dietary changes advocated by this “evidence-based” program, I found this document which describes the CDC curriculum that Medicare requires participants (providers and patients) to follow for provider reimbursement and for, theoretically, the patients' successful sustained weight loss and diabetes prevention.

https://www.cdc.gov/diabetes/preven...riculum_TOC.pdf

Of note, during the first 6 months of the curriculum, the topics include such things as “Be a Fat and Calorie Detective” and “Three Ways to Eat Less Fat and Fewer Calories.” And during the second 6 weeks, topics such as “Fats - Saturated, Unsaturated, and Trans Fat” and “More Volume, Fewer Calories.”

But not a word about carbs!

And we're going to be PAYING for this?!

Also, of interest, I ran across this fact sheet https://innovation.cms.gov/Files/fa...cy2018fr-fs.pdf that outlines the program's fee payments to providers based upon patient performance, essentially, the greater the patient's weight loss and the longer the weight loss is maintained, the more the provider is paid.

With fee generation contingent upon patient success in the program, it seems providers involved in this program would want to utilize the dietary guidelines, such as LCHF, that actually work toward weight loss and prevention of type 2 diabetes, not the old calorie-in-calorie-out and fat-will-kill-you rants.

What can the CDC be thinking here? Evidence based? Are they really discounting everything that has been coming out of Low Carb Breckenridge? It appears so.

I am not a lawyer, nor did I read any of it. Nevertheless, my opinion follows.

Medicare is insurance, and like any other insurance, claims can be decided in court, and the court has its own rules. In the documents (which I did not read, but whatever), it seems there's two aspects to consider. First it's the method prescribed to conform (i.e. be eligible for coverage), and second it's the outcome required to obtain compensation. These two aspects can be further distinguished. For the first, the pertinent part is "conform", not "method prescribed", meaning that if one conforms regardless of method, one is eligible. For the second, the pertinent part is "outcome", meaning that if one produces prescribed outcome, one is entitled to compensation.

In the event a claim is made by the insured, if "method prescribed" was not followed as written, and since that's not the pertinent part yet can still be enforced, the rule here is what's called demonstrably justifiable, i.e. one has to demonstrate that one's method is justified (i.e. effective in conforming, but more specifically equally effective as whatever is prescribed by the clause) and this must be done in court. Ya it's a hassle but the good news is that for this clause (method prescribed) to be ruled invalid, only a single case needs to be argued successfully, then it creates a precedent. As a bonus, this can then be used to refute pretty much all the BS coming from the official guidelines and whatever else gets in the way of whatever alternative method is in fact demonstrated to be successful.

A parallel can be drawn with theft insurance where certain clauses can prescribe specific methods to make it harder for thieves to steal your crap, in order to be eligible for coverage and subsequently for compensation in the event of theft. We know all about theft and thieving methods and methods to prevent theft, so those clauses are pretty much standard, but there's still some who will try to put in absurd requirements, which the court is only happy to shoot down. Personally for example, I remember an insurance claim by a youth club way back, where stuff was stolen, but the insurer didn't pay, because the theft did not occur during a fire, which is what the insurance clause stated should occur in order to conform and be entitled to compensation. In other words, the place was not insured for theft nor fire, but only for theft during a fire. To illustrate the absurd. In order to conform to that clause, somebody would have to start a fire when he was being robbed, but then that would make him a fraud because arson is a crime. On the other hand, it's possible to be robbed during a fire since everybody (besides the thieves, of course) would get the hell out and nobody would be looking out for thieves.

Finally, whoever thought it would be a good idea to invade Medicare to push his own low-fat agenda, it's all gonna blow up in his face, because now it ain't just talk, it's the Law they're dealing with, and when it comes to Law, the court rules.

Anyways, until such hypothetical court ruling, here's what's gonna happen.

Whatever happens, low-fat will remain king on paper. People will try to conform, but will fail, so won't get coverage or compensation - Medicare costs less - success at the legislative level, i.e. look, we reduced health care costs! And, patients will be blamed for that failure precisely by pointing out they didn't follow prescribed method, which is "evidence-based" after all so it must be true! That's a bit of irony because failure of the prescribed method will be held as proof of its validity. Whoever will succeed with prescribed method will be held as proof low-fat is king.

Again, I am not a lawer, nor did I read the documents. Nor am I going to read them. No point.

Sickening ...

Yes, my first thought was, well, this program is going to prove our case for us when the results of the low carb vs low fat dietary changes come in. But I was then deflated by the news that participants must adopt CDC's low fat approach. Under your legal layperson's theory, though, our LCHF docs might be able to argue for fee payment if their patients meet program goals using dietary guidelines other than the CDC's...? Don't worry -- it's a rhetorical Q only. Just fun to think about.

As always, nicely argued, M Levac.

I think Virta Health has a bearing on this too; we have competition operating, so to speak.

I bet you didn't know red meat causes diabetes according to the American Diabetes Association.

Seems the only thing we can trust anymore is ourselves and our fellow citizens. It's another example of "Don't ask, don't tell." As long as my numbers are good, she won't ask me how I do it. This way there's no prob with compensation. Maybe if I were T2D it would be different.

According to my red meat pot roast I'm about to cook, ADA causes diabetes!

Well stated. The day is coming in the U.S. where those who don't follow the standards of care, whether it's a dietary approach or refusing to take prescribed medications, will be deemed a higher risk and pay more or lose coverage. It's driving people to accept prescriptions for medications and not take them, and distort how they eat in order to retain coverage. Interesting for those of us who get excellent results in tests and have good health by following what is considered a contrarian dietary approach, it definitely becomes "Don' tell."

Sounds like a setup to me. Follow these guidelines, if you succeed we will pay you. but the guidelines are designed to make you fail. So no payments will be made.
Bonus, you stay sick, so they make more money.

my thoughts when reading the first post.

The drug companies are the only ones that will gain anything from this!

Another point I just thought of. It seems the focus is on calories, with fat and volume of food being merely proxies for calories, i.e. fat contains twice the calories as carbs, therefore eating less fat is the best way to eat less calories. The whole deal with calories is gaining and losing weight in the context of obesity. The whole deal with obesity is that it's blamed for a bunch of other diseases, i.e. obesity becomes the cause.

Low-carb is shown to do two things right off the bat, before we measure anything else. First, we lose fat. Obesity is fixed, conformance with prescription is established. Second, we eat less. The calories focus is adhered to, conformance with prescription is established again.

The fact that low-carb means to eat more fat could arguably be pointed at as failure to conform. However, since eating less fat is merely a proxy to the main prescription which is to eat fewer calories, the method used to eat fewer calories becomes irrelevant, so long as the effect is the same - we eat less.

If we argued that other measures are the focus, for example disease markers such as cholesterol and triglycerides and HbA1c and blood glucose and blood pressure and you-name-it, low-carb actually fixes this even in the absense of weight loss.

The best part is that there is actual genuine experimental evidence published in reputable scientific journals to support all of it. This ain't just a game of show your food log from yesterday.

Eating less fat (especially less saturated fat) could be argued as a way to prevent heart disease, so that low-carb could be argued to accelerate heart disease. However, since heart disease is deemed to be subsequent to obesity in the grand idea about calories->obesity->all other diseases, it becomes moot.

Just illustrating the logic, not arguing a hypothetical case.