Background:
Insurance companies often require a mandated pre surgical weight loss program prior to bariatric surgery. It is debated whether this would improve weight loss after surgery. We argue that the authority deciding the indications, duration and type of preoperative program should be the operating bariatric surgeon, who may be able to tailor these programs to suit individual needs.
Objective: To compare the outcomes (BMI and co-morbidities) in patients undergoing bariatric surgery with and without mandated preoperative weight loss program
Methods:
Retrospective chart review of all patients undergoing Laparoscopic
Roux-en-Y gastric bypass between 2008-2010. The study population was divided into two groups- insurance mandated preoperative weight loss program required and insurance mandated preoperative weight loss program not required. Primary outcome was improvement in BMI at 6 months, 1 year and two years post-surgery.
Results:
Total of 49 patients were enrolled- 32 under mandated weight loss required (group A) and 17 under mandated weight loss not required (Group B). Mean BMI (kg/m2) preoperative, at 6months, 1 year and 2 years in Group A was 50, 36, 32.1, 30.77 respectively. Mean BMI (kg/m2) of Group B preoperative, at 6 months, 1 year and 2 years in group B was 48.47, 38.69, 31.1 and 30.85 respectively. There was no statistical significance between the two groups. When improvement in terms of co-morbidities i.e. Hypertension, Type II Diabetes Mellitus and Obstructive Sleep Apnea were analyzed there was no significant difference. There was average of 4.5 months delay in the wait time in patients requiring the weight loss program (p = 0.08).
Conclusions:
This preliminary study demonstrates that there is no added benefit with pre-operative weight loss programs with regards to most post operative outcomes. Instead there is excessive delay which may actually result in patient dropout and attrition leading to poor health care outcomes in this group. Larger multi-centric studies are needed to further confirm this.