ASMBS updated position statement on insurance mandated preoperative weight loss requirements

Kim, Julie; Rogers, Ann M.; Ballem, Naveen; Schirmer, Bruce D.

doi:10.1016/j.soard.2016.04.019

Cited by 106 publications

(41 citation statements)

References 32 publications

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“…Multiple studies have found that insurance‐mandated preoperative weight loss either has no effect on weight loss or delays treatment and may lead to inferior weight loss . Multiple position statements by the American Society for Metabolic and Bariatric Surgery have recommended abandoning insurance‐mandated preoperative weight loss .…”

Section: Current Challengesmentioning

confidence: 99%

Mental Health in Bariatric Surgery: Selection, Access, and Outcomes

Morledge

Pories

2020

Obesity

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Severe obesity has many psychiatric consequences that can be influenced by bariatric surgery. The goal of this article is to review these challenges, including the mental health status of patients with severe obesity, the evaluation of surgical candidates, and the early and late effects of the operations, and to offer some recommendations to manage these challenges. The failure of the insurance‐mandated preoperative psychosocial evaluation is also discussed.

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Section: Current Challengesmentioning

confidence: 99%

Mental Health in Bariatric Surgery: Selection, Access, and Outcomes

Morledge

Pories

2020

Obesity

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“…A key difference between the two is the inclusion of a weight management program in the Alberta pathway, but whether the addition of weight management or a higher degree of patient engagement is responsible for higher retention is unclear. In other settings, the insurance-mandated requirement of successful completion of presurgical weight loss programs as a prerequisite for surgery has not been associated with improved post-surgical outcomes (30), and a position statement from the American Society for Metabolic and Bariatric Surgery notes that with a lack of data from randomized controlled trials, this practice leads to unnecessary delays and the progression of life-threatening comorbid conditions (31).…”

Section: Discussionmentioning

confidence: 99%

Earlier Provision of Gastric Bypass Surgery in Canada Enhances Surgical Benefit and Leads to Cost and Comorbidity Reduction

Davis

Saunders

2020

Front. Public Health

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Background: Effective provision of bariatric surgery for patients with obesity may be impeded by concerns of payers regarding costs or perceptions of patients who drop out of surgical programs after referral. Estimates of the cost and comorbidity impact of these inefficiencies in gastric bypass surgery in Canada are lacking but would aid in informing healthcare investment and resource allocation. Objectives: To estimate total and relative public payer costs for surgery and comorbidities (diabetes, hypertension, and dyslipidemia) in a bariatric surgery population. Methods: A decision analytic model for a 100-patient cohort in Canada (91% female, mean body mass index 49.2 kg/m 2 , 50% diabetes, 66% hypertension, 59% dyslipidemia). Costs include surgery, surgical complications, and comorbidities over the 10-year post-referral period. Results are calculated as medians and 95% credibility intervals (CrIs) for a pathway with surgery at 1 year ("improved") compared with surgery at 3.5 years ("standard"). Sensitivity analyses were performed to test independent contributions to results of shorter wait time, better post-surgical weight loss, and randomly sampled cohort demographics. Results: Compared to standard care, the improved path was associated with reduction in patient-years of treatment for each of the three comorbidities, corresponding to a reduction of $1.1 (0.68-1.6) million, or 34% (26-41%) of total costs. Comorbidity treatment costs were 9.0-and 4.7-fold greater than surgical costs for the standard and improved pathways, respectively. Relative to non-surgical bariatric care, earlier surgery was associated with earlier return on surgical investment and 2-fold reduction in risk of prevalence of each comorbidity compared to delayed surgery. Conclusions: Comorbidity costs represent a greater burden to payers than the costs of gastric bypass surgery. Investments may be worthwhile to reduce wait times and dropout rates and improve post-surgical weight loss outcomes to save overall costs and reduce patient comorbidity prevalence.

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“…Evidence does not support a minimum weight loss requirement to be eligible for surgery, nor is this a requirement of sites participating in the Teen–Longitudinal Assessment of Bariatric Surgery (Teen‐LABS) registry (a collaboration of 5 US adolescent bariatric surgery sites). Arbitrary weight loss requirements employed by insurance carriers have not affected outcomes or failure rates 19 , 20 …”

Section: Adolescent Patient Selection For Wlsmentioning

confidence: 99%

Weight Loss Surgery in Adolescents

Christison

Gupta

2017

Nut in Clin Prac

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Childhood obesity continues to be a national health problem, with growing numbers of adolescents (8.7%) affected by severe obesity and its associated cardiometabolic risks. Since current nonsurgical methods for treating these adolescents have only modest effects, weight loss surgery (WLS) is an alternative treatment. An overview of the literature was conducted describing the selection, management, and outcomes of adolescents undergoing WLS. Adolescent guidelines require physical and emotional maturity as well as serious comorbidities associated with body mass index cutoffs higher than those used for adults. Medium-term to long-term outcomes are similar to those of adults undergoing WLS. Such outcomes depend on management by a multidisciplinary team with expertise in caring for adolescents who are still developing psychosocially and who are relatively more dependent on family supports for continued care. Future exploration is needed to elucidate optimal surgical indications for adolescents, improved adherence to postoperative care, and the impact of WLS on life expectancy. Resulting evidence can better inform the direction for healthcare delivery and policy directed toward this at-risk population.

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ASMBS updated position statement on insurance mandated preoperative weight loss requirements

Cited by 106 publications

References 32 publications

Mental Health in Bariatric Surgery: Selection, Access, and Outcomes

Mental Health in Bariatric Surgery: Selection, Access, and Outcomes

Earlier Provision of Gastric Bypass Surgery in Canada Enhances Surgical Benefit and Leads to Cost and Comorbidity Reduction

Weight Loss Surgery in Adolescents

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