Insurance-mandated Weight Management Programs Prior to Bariatric Surgery Offer No Clinical Benefit

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Mandated completion of a weight management program (WMP) prior to undergoing bariatric surgery provides no long-term clinical benefit according to research presented at the American Society for Metabolic and Bariatric Surgery’s (ASMBS) annual meeting.

“Insurance-mandated WMP completion prior to bariatric surgery does not result in short- or long-term clinical benefit and should be abandoned,” wrote study authors led by Deborah Hutcheon, DCN, RD, CSOWM, LD, a clinical nutrition specialist at Prisma Health in Greenville, SC.

Specific requirements of WMP differ among insurers, according to a statement from the ASMBS. Some only require that a patient complete the program. Others prescribe time periods during which patients are expected to maintain weight; still others may deny payment for surgery if a patient’s weight fluctuates. Duration of the programs also varies, ranging from 3 to 12 months, says ASMBS.

Rationale for the requirement centers on the belief among many payers that going through the WMP prior to surgery will reduce patient complications, improve health outcomes, and reduce health care costs.

“Believing is one thing, proving is another,” said Hutcheon in the statement. “Patients in the insurance-mandated weight management programs did not achieve greater weight loss before or after bariatric surgery, did not have fewer post-operative complications, and did not have better resolution of obesity-related diseases when compared to patients who had no such insurance requirement." Their research, she adds, shows that participation in fact “diminished” outcomes and “unnecessarily delayed patient access to a life-saving medical intervention.” 

WMP vs no WMP

In the single-institution retrospective study, Hutcheon and colleagues evaluated the association between insurance-mandated weight management programs (WMPs) and long-term postoperative outcomes in 1056 patients who underwent laparoscopic gastric bypass (GB, n = 572 patients) or sleeve gastrectomy (SG, n = 484 patients) between 2014 to 2019. Among them, 779 completed an insurance-mandated WMP.

Their primary endpoints of interest were follow-up rate, percent total weight loss, and percent excess weight loss through post-surgical month 60. The team also evaluated secondary outcomes that included surgery time, surgical site infections, ED visits, length of stay, and readmissions.

At the 5-year follow-up, the researchers write, differences were not statistically significantly between WMP and non-WMP groups for rate of follow-up, percent total weight loss, or percent excess weight loss for either procedure.

They reported that patients who underwent GB who had not attended a WMP did maintain greater percent total weight loss (32.22+/-7.83% vs 25.73+/-10.58%, p=.09) and percent excess weight loss (71.78+/-20.26% vs 58.60+/-25.69%, p=.24) up to 60 months post-surgery than those who underwent GB but had not completed WMP.

Similarly, according to the study, patients who underwent SG without prior WMP maintained greater percent total weight loss (22.52+/-8.93% vs 21.41+/-9.25%, p=.45) and percent excess weight loss (44.26+/-21.62% vs 41.62+-21.11%, p=.38) up to 13 months after surgery.

On average, according to ASMBS, the patients who did not complete a WMP had 1% to 5% more weight loss. The analysis found no differences in secondary outcomes either by type of surgery or WMP completion, suggesting that the WMP requirement does not lead to observable clinical benefits, said Hutcheon et al.

“Every day delayed is another day denied access to the most effective long-term treatment for obesity,” said bariatric surgeon and ASBMS president-elect Teresa LaMasters, MD, in the press statement. “The preparation of the patient for metabolic bariatric surgery rests with the surgeon in collaboration with a multidisciplinary team. Arbitrary barriers should not stand in the way of these life-saving procedures.” (Dr LaMasters was not involved in the study.)

Reference: Hutcheon D, Ewing J, St Ville M, et al. Insurance-mandated weight management program completion prior to bariatric surgery provides no long-term clinical benefit. Paper presented at the annual meeting of the American Society for Metabolic and Bariatric Surgery; June 5-9, 2022; Dallas, TX.