As many of you know, the ASMBS had their Annual Convention in Las Vegas last week and now the journals are starting to pour out a ton of information from that meeting.  I’ve been slacking of late, but I’m going to start putting in the things that they’ve churned out from the meeting as it directly relates to the WLS community.  Maybe not nutrition-wise, but still.

Something to place in the “duh” pile that many of us “old timers” could have told you..

From Medscape:

No Benefits With Insurance-Mandated Medical Programs for Bariatric Patients

Nancy A. Melville

June 29, 2010 (Las Vegas, Nevada) — Patients planning to undergo bariatric surgery who are mandated by their insurance companies to complete medical programs beforehand do not have greater rates of weight loss than those not required to complete the programs. In fact, these patients are often subjected to significant, unnecessary delays in surgery, according to a study presented here at the American Society for Metabolic and Bariatric Surgery 27th Annual Meeting.

Obese patients seeking bariatric surgery as a last resort for weight loss are commonly faced with the unexpected requirement of completing a lengthy medical program before their coverage will be approved, bariatric surgeon Timothy Kuwada, MD, from the Carolinas Medical Center in Charlotte, North Carolina, the study’s lead investigator, told meeting attendees.

“Insurance coverage for bariatric surgery varies, and companies that do cover the surgery often require presurgery programs that can range anywhere from 3 to 12 months,” he explained. “Yet there are no definitive data to support these mandated medical programs [MMPs].”

In an effort to determine the effects of such programs on pre- and postoperative weight loss, Dr. Kuwada and fellow researchers collected prospective data on 440 patients who underwent bariatric surgery, 327 of whom underwent nonrevisional laparoscopic gastric bypass and 113 of whom underwent adjustable gastric banding between August 2006 and 2010.

Of the patients, 324 were not in plans that required their participation in a MMP, and 116 patients did go through the programs, which involved spending at least 6 months under the direction of medical bariatricians and nutritionists.

The researchers found no significant difference between the 2 groups in terms of preoperative excess weight loss or excess weight loss at 6 and 12 months after surgery.

Patients in the MMP group did lose 2 pounds more than the non-MMP group in the preoperative period; however, that difference was not statistically significant.

After 1 year, gastric bypass patients in the non-MMP group had lost 64% of their excess weight, compared with patients in the MMP group, who lost about 63%.

Among laparoscopic adjustable gastric band patients, excess weight loss in the MMP group was 37%, compared with 30% in the non-MMP group; that difference was also not statistically significant.

The MMP patients waited an average of 282 days for surgery, whereas the non-MMP patients waited an average of 177 days.

The researchers noted that all bariatric surgery patients typically received physician-directed nutritional and psychological counseling for about 2 months prior to their surgery, and all were placed on a standardized low-calorie diet 2 weeks before surgery.

“It’s clear that mandated medical programs do not confer any significant benefits in pre- or postoperative weight loss,” Dr. Kuwada said. “The programs do, however, significantly delay surgery, in our study by as much as 100 days.”

“Based on these findings, we recommend that insurance companies abandon the requirement for mandatory preoperative medical programs.”

Delaying an expensive surgery for 1 or 2 quarters might benefit insurance companies in terms of their quarterly bottom line, but it is unfairly disadvantageous to patients, said bariatric surgeon and session moderator Marina Kurian, MD, medical director of the New York University Weight Management Program in New York City.

“What it really says to patients is ‘You don’t have a disease that’s severe enough for surgery right now and we don’t think you’ve really tried to lose weight’,” she told Medscape General Surgery. “It’s a very negative message and I think it beats down on an already beaten-down psyche.”

“These people are already upset and depressed about their weight. They already feel guilty that they have reached this weight, and having the surgery put off for 2 quarters only adds to the problem,” said Dr. Kurian.

Most presurgery dietary programs require patients to have monthly visits with their primary care providers, who are typically not trained to handle such cases. The study’s finding of no significant differences in presurgery weight loss between patients in the MMPs and those not required to take them only underscores that the approach is ineffective, she noted.

“No one requires smoking cessation programs before a coronary bypass. No one requires smoking cessation programs before cancer surgery. But they require this attempt at a 6-month or 3-month doctor-supervised diet where patients have to see their doctor every month in order to have their weight loss surgery covered,” Dr. Kurian said.

“I think it speaks to the bias against obesity and to the fact that this is the second most common operation in the country.”

The study did not receive any funding. Dr. Kuwada and Dr. Kurian have disclosed no relevant financial relationships.

American Society for Metabolic and Bariatric Surgery (ASMBS) 27th Annual Meeting: Abstract PL-201. Presented June 25, 2010.

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2 Responses to “ASMBS: Insurance-mandated pre-req’s not beneficial”

  1. MacMadame says:

    It may be a big “duh” to you and me, but I have gotten into so many arguments with pre-ops and even post-ops who had to go through these programs who insist that they are beneficial, that they weed out the unprepared, that they make you more successful post-op, etc., etc., etc.

    I think they don’t want to believe that they are jumping through all these hoops for nothing.

    Plus, arguing with them makes it seem like you are saying no one should do research and be prepared or lose a little weight pre-op. And that’s not what we’re saying at all.

  2. Lisa Melvin says:

    I was fortunate in that my ins. did not require any MMP.. once I meet my deductible, they pay.

    Also no pre-op diet. I don’t know if I would’ve been AS successful if I had had to be on one. Since I wasn’t deprived pre-surgery, I had good energy stores for recovery & wasn’t frustrated with the gradual return to “normal” food.

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