Background

There is no evidence that insurance-mandated weight loss prior to bariatric surgery impacts outcomes. This study evaluated the relationship between insurance-mandated weight management program (WMP) completion before primary bariatric surgery and long-term post-operative outcomes.Methods: Patients who underwent laparoscopic Roux-en-Y gastric bypass (LRYGB, n=572) or sleeve gastrectomy (LSG, n=484) from 2014-2019 were dichotomized to presence (LRYGB n=431, LSG n=348) or absence (LRYGB n=141, LSG n=136) of insurance-mandated WMP completion. Primary endpoints included follow-up rate, percent total weight loss (%TWL), percent excess weight loss (%EWL) through 60 months post-operation. Operation time, length of stay, surgical site infections, emergency department visits, readmissions, reoperations, and intravenous fluid administration were also analyzed. T-tests compared between group means with significance p<0.05.Results: Follow-up rate, %TWL, %EWL were no different (p=NS) up to 60 months post-operation between groups for either surgery. LRYGB patients without WMP completion maintained greater %TWL and %EWL up to 60 months post-operation; those seen at 60 months (n=19) without WMP completion (n=6) maintained greater %TWL (32.22+-7.83% vs 25.73+-10.58%, p=0.087) and %EWL (71.78+-20.26% vs 58.60+-25.69%, p=0.244). LSG patients without WMP completion maintained greater %TWL and %EWL up to 13 months post-operation; those seen at 13 months (n=281) without WMP completion (n=76) maintained greater %TWL (22.52+-8.93% vs 21.41+-9.25%, p=0.449) and %EWL (44.26+-21.62% vs. 41.62+-21.11%, p=0.383). No differences (p=NS) existed in secondary outcomes by surgery type and WMP completion.Conclusions: Insurance-mandated WMP completion prior to bariatric surgery does not result in short- or long-term clinical benefit and should be abandoned.

Methods

Patients who underwent laparoscopic Roux-en-Y gastric bypass (LRYGB, n=572) or sleeve gastrectomy (LSG, n=484) from 2014-2019 were dichotomized to presence (LRYGB n=431, LSG n=348) or absence (LRYGB n=141, LSG n=136) of insurance-mandated WMP completion. Primary endpoints included follow-up rate, percent total weight loss (%TWL), percent excess weight loss (%EWL) through 60 months post-operation. Operation time, length of stay, surgical site infections, emergency department visits, readmissions, reoperations, and intravenous fluid administration were also analyzed. T-tests compared between group means with significance p<0.05.Results: Follow-up rate, %TWL, %EWL were no different (p=NS) up to 60 months post-operation between groups for either surgery. LRYGB patients without WMP completion maintained greater %TWL and %EWL up to 60 months post-operation; those seen at 60 months (n=19) without WMP completion (n=6) maintained greater %TWL (32.22+-7.83% vs 25.73+-10.58%, p=0.087) and %EWL (71.78+-20.26% vs 58.60+-25.69%, p=0.244). LSG patients without WMP completion maintained greater %TWL and %EWL up to 13 months post-operation; those seen at 13 months (n=281) without WMP completion (n=76) maintained greater %TWL (22.52+-8.93% vs 21.41+-9.25%, p=0.449) and %EWL (44.26+-21.62% vs. 41.62+-21.11%, p=0.383). No differences (p=NS) existed in secondary outcomes by surgery type and WMP completion.Conclusions: Insurance-mandated WMP completion prior to bariatric surgery does not result in short- or long-term clinical benefit and should be abandoned.

Results

Follow-up rate, %TWL, %EWL were no different (p=NS) up to 60 months post-operation between groups for either surgery. LRYGB patients without WMP completion maintained greater %TWL and %EWL up to 60 months post-operation; those seen at 60 months (n=19) without WMP completion (n=6) maintained greater %TWL (32.22+-7.83% vs 25.73+-10.58%, p=0.087) and %EWL (71.78+-20.26% vs 58.60+-25.69%, p=0.244). LSG patients without WMP completion maintained greater %TWL and %EWL up to 13 months post-operation; those seen at 13 months (n=281) without WMP completion (n=76) maintained greater %TWL (22.52+-8.93% vs 21.41+-9.25%, p=0.449) and %EWL (44.26+-21.62% vs. 41.62+-21.11%, p=0.383). No differences (p=NS) existed in secondary outcomes by surgery type and WMP completion.Conclusions: Insurance-mandated WMP completion prior to bariatric surgery does not result in short- or long-term clinical benefit and should be abandoned.

Conclusions

Insurance-mandated WMP completion prior to bariatric surgery does not result in short- or long-term clinical benefit and should be abandoned.