Weight management program requirement for bariatric surgery 'should be abandoned'

Insurance-mandated weight management programs prior to bariatric surgery are ineffective “and should be abandoned,” according to researchers.

Deborah Hutcheon, DCN, RD, CSOWM, LD, a clinical nutrition specialist at Prisma Health in Greenville, S.C., and colleagues reported that the controversial requirement does not provide any clinical benefit at the American Society for Metabolic and Bariatric Surgery’s (ASMBS) annual meeting.

Before being approved for bariatric surgery, many insurance companies require patients to undergo a weight management program because they believe these programs result in better outcomes for patients. Each insurance company has its own set of requirements: some just require patients to complete a program, while others require patients to maintain weight loss and may even deny surgery if their weight fluctuates, according to an ASMBS press release.

Hutcheon and colleagues evaluated the association between insurance-mandated weight management programs (WMPs) and long-term postoperative outcomes in more than 1,000 patients who underwent laparoscopic gastric bypass (n = 572 patients) or sleeve gastrectomy (n = 484 patients) from 2014 to 2019. Among them, 779 completed an insurance-mandated WMP.

The researchers compared the percent total weight loss and percent excess weight loss in participants who completed a WMP with those who did not during a postoperative period of 60 months. They also analyzed secondary outcomes, including operation time, surgical site infections, ED visits, length of stay and readmissions.

The percent total weight loss and percent excess weight loss were not significantly different between the groups after the follow-up period. In fact, patients who underwent laparoscopic gastric bypass but did not complete a WMP maintained greater weight loss and excess weight loss up to 60 months post-surgery than those who completed a WMP, the researchers reported. Additionally, patients who underwent sleeve gastrectomy but did not complete a WMP maintained greater weight loss and excess weight loss up to 13 months post-operation. On average, patients who did not complete the WMP had 1% to 5% more weight loss, according to the release.

There were no differences in secondary outcomes, leading the researchers to conclude that the requirement of a WMP does not lead to short- or long-term clinical benefits.

“Believing is one thing, proving is another. Patients in the insurance-mandated weight management programs did not achieve greater weight loss before or after bariatric surgery, did not have fewer postoperative complications, and did not have better resolution of obesity-related diseases when compared to patients who had no such insurance requirement,” Hutcheon said in the release. “The data shows the requirement only served to diminish outcomes and unnecessarily delay patient access to a life-saving medical intervention.”

References:

• Hutcheon D, et al. Abstract A002. Presented at: American Society for Metabolic and Bariatric Surgery Annual Meeting; June 5-9, 2022; Dallas.
• Insurance-mandated weight management program before weight-loss surgery provides no clinical benefit. https://www.eurekalert.org/news-releases/954732. Published June 7, 2022. Accessed Jun 9, 2022.