New Reimbursement for the Support of Overweight Children by Registered Dietitians in Belgium
As in most parts of the affluent world, the prevalence of obesity in Belgium is still increasing.
This will lead to comorbidities, increase of sick leave, loss of income, reduced quality of life for the patient and rising healthcare expenses for the government. In 2018, 49.3% of the Belgium adults (18-65 years of age) reported being overweight (BMI > 25) and 15.9%, obese compared to 41% and 10.8% respectively in 1997. The percentage of overweight children (2-17 years of age) increased from 13.6% in 2017 to 19% in 20018 and 5.8% of the children were reported obese in 2018.
In view of the concerns about the obesity epidemic and especially childhood obesity in Belgium, initiatives were taken not only by the Belgian dietetic organisations to create awareness among the populace through publicity campaigns. Politicians also organised a hearing at the Belgian Federal Parliament on a broad Belgium approach to obesity and childhood obesity in particular. The President of the Flemish Dietetic Association (FDA) was invited too and expressed the FDA’s vision on this matter. This resulted in an announcement of the Federal Minister of Health, Mrs De Block in November 2018 about an agreement with the National Institute for Health and Disability Insurance (NIHDI) to reserve a yearly budget of 5 million Euro for dietary advice and follow up of obese children (age 6-17) by 2020.
Subsequently, early 2019, both Presidents of the Francophone and Flemish Dietetic Organisations (Hélène Lejeune and Rian van Schaik)
were respectively invited at the Ministry of Health, to discuss the conditions for reimbursement of dietitians for the treatment by of obese children. The Presidents also advocated the inclusion of prevention of obesity by treating overweight children too. In the latter case, the emphasis should not solely be on energy restriction but on improvement of the food pattern and life style of the child and of their parents/family. Therefore, dietitians responsible for treatment of overweight children should also be trained in motivational coaching techniques.
The original plan of the Ministry of Health was to reimburse six 30 minutes consultations by a dietitian just for one year. The Presidents pleaded however for a follow up by the dietitian of five (5),5 hours in total over two years, since lifestyle changes usually take at least 2 years according to scientific literature. This amendment was included in the final treatment plan. From 1st April 2020, reimbursement for the treatment of overweight and obese children by dietitians will be available upon declaration of cost of 40 Euro per hour to the NIHDI.
For patients, this means in practice, an out of pocket expense of 25% of the 40 Euro per hour, and in cases of recognized low income earners, 10%.
Reimbursement of the dietitian is made dependent on the condition that treatment requires written referral by the family physician or paediatrician. Furthermore, reimbursement for this treatment will be available only once during childhood.
It is hoped that these changes in reimbursements will contribute to better treatment by the dietitians of overweight and obese children, leading to a healthier lifestyle and wellbeing in later life, which should be cost-effective.
Rian van Schaik Hélène LejeuneLejeune
VBVD (Flemish Association UPDLF(French-speaking of Dietitians) Dietitians)