Insurance-Mandated Medical Weight Management Programs in Sleeve Gastrectomy Patients Do Not Improve Postoperative Weight
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ORIGINAL CONTRIBUTIONS
Insurance-Mandated Medical Weight Management Programs in Sleeve Gastrectomy Patients Do Not Improve Postoperative Weight Loss Outcomes at 1 Year Toghrul Talishinskiy 1
&
Melissa Blatt 1 & Themba Nyirenda 1 & Sebastian Eid 1 & Hans Schmidt 1 & Douglas Ewing 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background/Introduction Qualification for bariatric surgery is based upon strict medical guidelines, but individual insurance companies may introduce additional requirements for approval and coverage as they deem necessary. A mandatory preoperative medical weight loss management (MWM) program is commonly such a requirement. Objective The primary objective of this study is to assess the effect of MWM programs on weight loss outcomes. Methods A retrospective review of all sleeve gastrectomies performed between 2012 and 2016 at our institution was conducted. Patients were divided into two groups: those who required a preoperative MWM program, and those who did not. A 1:1 greedy nearest-neighbor method matching algorithm was used to match patients based on age, BMI, smoking, gender, race, sleep apnea, and diabetes. Total weight loss and percent excess weight loss at 1 year for each group were compared. Results A total of 3059 sleeve gastrectomy patients were reviewed. Of these, 941 patients had adequate data points to be evaluated. The matching algorithm resulted in 530 patients for the final analysis, 265 patients in each group. There were no significant differences between the groups in terms of age, BMI, smoking, gender, race, sleep apnea, or diabetes. A paired t test found no significant differences between the MWM group and the control group at 1 year in both total weight loss (36.7 kg vs 36.2 kg) and in percent excess weight loss (56.5% vs 55.8%, p = 0.24). Conclusion There was no significant difference in weight loss outcomes after 1 year in patients required by insurance to participate in MWM programs compared to those who were not. The necessity of these programs should be questioned. Keywords Sleeve . Bariatric surgery . Insurance . Diet . Preoperative weight loss
Obesity is a complex, chronic disease process with an increasing incidence worldwide. The prevalence of obesity in the USA in 2015–2016 was 39.8%, totaling approximately 93.3 million adults [1]. The National Institutes of Health (NIH) 1991 Consensus Development Conference Statement on gastrointestinal surgery for severe obesity demonstrated the efficacy of surgical approaches to weight loss and established a basic framework for the approach to such patients [2]. The NIH consensus panel did recommend that “patients seeking therapy for severe obesity for the first time should be considered for treatment in a nonsurgical program,” but did not
* Toghrul Talishinskiy [email protected] 1
Hackensack University Medical Center, Hackensack, NJ, USA
specifically recommend either the duration of such a program nor the amount of weight to be lost prior to surgery [2–4]. Bariatric surgery
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