title: Insurance-mandated preoperative dietary counseling does not improve outcome and increases dropout rates in patients considering gastric bypass surgery for morbid obesity.
abstract: BACKGROUND
  Preoperative dietary counseling (PDC) before bariatric surgery is mandated by a growing number of insurance payers. Their claim is that PDC improves outcomes and postoperative compliance. We compared outcomes of GBP patients undergoing a mandatory 13 weeks of PDC (n = 72) to a contemporaneous group of patients with no such requirement (no-PDC; n = 252) who underwent operation between January 2000 and December 2002.
  
  
  METHODS
  The PDC and no-PDC groups were characterized by similar male:female ratios (1:4 vs 1:4.6), mean age (42 years), mean body weight (324 lb vs 309 lb), and mean body mass index (BMI) (52 kg/m2 vs 50 kg/m2). The PDC group had a higher incidence of obstructive sleep apnea compared with the no-PDC group (41% vs 28%; P < .04) but otherwise the two groups had similar incidences of obesity-related comorbidities. The presurgery dropout rate was 50% higher in the PDC group than in the no-PDC group (28% vs 19%; P < .05).
  
  
  RESULTS
  At 1 year follow-up, the no-PDC patients had a statistically greater percentage excess weight loss (67% vs 60%; P < .0001), lower BMI (32 vs 35; P < .015), and lower body weight (197 vs 218; P < .01). Resolution of major comorbidities, complication rates, 30-day postoperative mortality, and postoperative compliance with follow-up were similar in the two groups.
  
  
  CONCLUSIONS
  The data demonstrate that insurance-mandated PDC is an obstacle to patient access for surgical treatment of severe obesity and has no impact on weight loss outcome or postsurgical compliance. PDC should be abandoned by the insurance industry.
authors.affiliation: Department of Surgery, Division of Minimally Invasive Surgery, Virginia Commonwealth University Health System, Richmond, Virginia, USA. jamalm@mail.medicine.uiowa.edu
authors.forename: Mohammad K
authors.initials: MK
authors.lastname: Jamal
authors.forename: Eric J
authors.initials: EJ
authors.lastname: DeMaria
authors.forename: Jason M
authors.initials: JM
authors.lastname: Johnson
authors.forename: Brennan J
authors.initials: BJ
authors.lastname: Carmody
authors.forename: Luke G
authors.initials: LG
authors.lastname: Wolfe
authors.forename: John M
authors.initials: JM
authors.lastname: Kellum
authors.forename: Jill G
authors.initials: JG
authors.lastname: Meador
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D003376:Counseling; D004038:Diet, Reducing / Q000523:psychology*; D005260:Female; D015390:Gastric Bypass; D006801:Humans; D007348:Insurance, Health; D008297:Male; D009767:Obesity, Morbid / Q000523:psychology* / Q000601:surgery*; D010352:Patient Dropouts / Q000706:statistics & numerical data*; D011300:Preoperative Care; D016896:Treatment Outcome