Insurance-mandated preoperative diet and outcomes after bariatric surgery

Keith, Charles J.; Goss, Lauren; Blackledge, Camille; Stahl, Richard; Grams, Jayleen

doi:10.1016/j.soard.2018.01.017

Cited by 24 publications

(7 citation statements)

References 17 publications

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“…In another observational study, preoperative weight loss was not associated with greater postoperative weight loss, comorbidity resolution at 1 year, or lower 30‐ or 90‐day rates of readmission . In fact, Keith et al found that insurance‐mandated preoperative diets delay treatment and adversely affect weight outcomes. On the other hand, Deb et al also found that pre‐operative weight loss did not affect long‐term postoperative weight‐loss outcomes.…”

Section: Executive Summarymentioning

confidence: 97%

Clinical Practice Guidelines for the Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures – 2019 Update: Cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic and Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists

Mechanick

Apovian

Brethauer

et al. 2020

Obesity

Self Cite

324

464

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Objective The development of these updated clinical practice guidelines (CPGs) was commissioned by the American Association of Clinical Endocrinologists (AACE), The Obesity Society (TOS), American Society for Metabolic and Bariatric Surgery (ASMBS), Obesity Medicine Association (OMA), and American Society of Anesthesiologists (ASA) Boards of Directors in adherence with the AACE 2017 protocol for standardized production of CPGs, algorithms, and checklists. Methods Each recommendation was evaluated and updated based on new evidence from 2013 to the present and subjective factors provided by experts. Results New or updated topics in this CPG include: contextualization in an adiposity‐based chronic disease complications‐centric model, nuance‐based and algorithm/checklist‐assisted clinical decision‐making about procedure selection, novel bariatric procedures, enhanced recovery after bariatric surgery protocols, and logistical concerns (including cost factors) in the current health care arena. There are 85 numbered recommendations that have updated supporting evidence, of which 61 are revised and 12 are new. Noting that there can be multiple recommendation statements within a single numbered recommendation, there are 31 (13%) Grade A, 42 (17%) Grade B, 72 (29%) Grade C, and 101 (41%) Grade D recommendations. There are 858 citations, of which 81 (9.4%) are evidence level (EL) 1 (highest), 562 (65.5%) are EL 2, 72 (8.4%) are EL 3, and 143 (16.7%) are EL 4 (lowest). Conclusions Bariatric procedures remain a safe and effective intervention for higher‐risk patients with obesity. Clinical decision‐making should be evidence based within the context of a chronic disease. A team approach to perioperative care is mandatory, with special attention to nutritional and metabolic issues.

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Section: Executive Summarymentioning

confidence: 97%

Clinical Practice Guidelines for the Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures – 2019 Update: Cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic and Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists

Mechanick

Apovian

Brethauer

et al. 2020

Obesity

Self Cite

324

464

View full text Add to dashboard Cite

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“…The widespread, but unproven, assumption that body weight is entirely controllable by lifestyle choices and that self-directed efforts can reverse even severe forms of obesity or type 2 diabetes 44 could explain the low level of public support for coverage of anti-obesity interventions beyond diet and exercise 45 , regardless of their evidence base. For example, many public and private health insurers either do not provide coverage or have substantive limitations in the coverage of metabolic surgery, including fulfilment of a number of criteria for which there is limited or no clinical evidence 46,47 . These attitudes are in stark contrast with coverage of treatment for other chronic diseases (for example, cancer, heart disease, and osteoarthritis) that are not conditional to similar restrictions, and for which use of similarly arbitrary coverage criteria would be socially indefensible and ethically objectionable.…”

Section: Summary Of Evidencementioning

confidence: 99%

Joint international consensus statement for ending stigma of obesity

Rubino

Puhl

Cummings

et al. 2020

Nat Med

655

605

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People with obesity commonly face a pervasive, resilient form of social stigma. They are often subject to discrimination in the workplace as well as in educational and healthcare settings. Research indicates that weight stigma can cause physical and psychological harm, and that affected individuals are less likely to receive adequate care. For these reasons, weight stigma damages health, undermines human and social rights, and is unacceptable in modern societies. To inform healthcare professionals, policymakers, and the public about this issue, a multidisciplinary group of international experts, including representatives of scientific organizations, reviewed available evidence on the causes and harms of weight stigma and, using a modified Delphi process, developed a joint consensus statement with recommendations to eliminate weight bias. Academic institutions, professional organizations, media, public-health authorities, and governments should encourage education about weight stigma to facilitate a new public narrative about obesity, coherent with modern scientific knowledge.

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“…The majority of third‐party payers require preoperative weight loss for patients seeking bariatric surgery . 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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Insurance-mandated preoperative diet and outcomes after bariatric surgery

Cited by 24 publications

References 17 publications

Joint international consensus statement for ending stigma of obesity

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

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