Insurance mandated weight management programs as a prerequisite for approval for bariatric surgery did not prove to benefit weight loss outcomes in patients, according to a study published online last month in Surgery for Obesity and Related Diseases.
Patient participation in a medical weight management program prior to bariatric surgery is required by many insurance companies before approval is granted for coverage.
The supposed benefit of this prerequisite is that it improves post-op outcomes and compliance, however there is much debate about whether or not this belief is supported by evidence.
About the Study
For the study, medical researchers from the Department of Surgery, NYU Langone Medical Center conducted a retrospective review of all bariatric surgery cases performed between 2009 and 2013.
Patients were put into one of two groups based on whether the insurance company required medical weight management or not. An algorithm was then used to control for differences between the groups and match patients by gender, age, body mass index (BMI), and surgery type (sleeve gastrectomy, gastric bypass, and gastric band).
The review included a total of 1432 bariatric surgery patients, then reduced to 560 patients for the final analysis using the bucket-matching algorithm. Patients in the study had a mean age of 41 years, a BMI of 43, and were 91% female.
The results showed that there were no significant differences in weight loss outcomes between patients who had been required to participate in a medical weight management (MWM) program and the comparison group without this prerequisite at 1 year and 2 years.
- At 1 year, total body weight loss was 21.3% (MWM group) vs 20.2%
- At 2 years, total body weight loss was 23.4% (MWM group) vs 21.5%
The results of this study suggest that insurance mandated medical weight management prior to bariatric surgery does not provide a significant benefit to patient weight loss outcomes.
ASMBS Position Statement
In 2011, the American Society for Metabolic and Bariatric Surgery issued a position statement regarding preoperative supervised weight loss requirements, stating:
- “It is the position of the ASMBS that the requirement for documentation of prolonged preoperative diet efforts before health insurance carrier approval of bariatric surgery services is inappropriate, capricious, and counter-productive given the complete absence of a reasonable level of medical evidence to support this practice. Policies such as these that delay, impede or otherwise interfere with life-saving and cost-effective treatment, as have been proven to be true for bariatric surgery to treat morbid obesity, are unacceptable without supporting evidence. Individual surgeons and programs should be free to recommend preoperative weight loss based on the specific needs and circumstances of the patient.”
Other studies have also examined this preoperative requirement and found similar results. The researchers in this study mention the need for longer-term studies to determine the benefit of this insurance requirement. The debate continues regarding this preoperative requirement.
Source: “Insurance-Mandated Medical Weight Management Prior to Bariatric Surgery” published online September 18, 2015 in Surgery for Obesity and Related Diseases; DOI: http://dx.doi.org/10.1016/j.soard.2015.09.004.