title: Factors affecting rejection of bariatric patients from an academic weight loss program.
abstract: BACKGROUND
  To determine the factors affecting rejection of bariatric candidates at an accredited, American College of Surgeons Level 1A, bariatric program. Bariatric surgery "Centers of Excellence" use a multidisciplinary team to screen patients for eligibility for surgery using insurance, medical history, psychological evaluation findings, and the surgeon assessment. Few studies have reported on the frequency or reasons for patients not being accepted for surgery among high-volume academic bariatric programs.
  
  
  METHODS
  From March to September 2007, 299 consecutive patients were accepted for evaluation into an accredited bariatric program and tracked for the incidence of rejection for weight loss surgery. The primary reasons for rejection included a lack of insurance coverage, being medically unfit, psychological or social inappropriateness, and a body mass index (BMI) that did not meet the cutoff (BMI<35 kg/m2 or <40 kg/m2 without co-morbid conditions).
  
  
  RESULTS
  Of 299 screened patients, 90 (30.1%) were not accepted for surgery by the multidisciplinary team. The most frequent reason was the lack of insurance coverage (47.8%). Primary care physicians were the most common source of patient referral. All but 1 of the patients excluded because of an inadequate BMI (n=13) had been referred by friends, co-workers, or themselves from information received from the Internet or television.
  
  
  CONCLUSIONS
  Approximately one third of screened patients were not accepted for surgery by an academic bariatric program. Self- or social referral appeared to correlate with rejection because the BMI did not meet the criteria for surgery. This suggests inadequate information among social referral networks and/or in the media. Long-term follow-up will determine the health outcomes of patients not cleared for weight loss surgery.
authors.affiliation: Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
authors.forename: Shawn
authors.initials: S
authors.lastname: Tsuda
authors.forename: Limaris
authors.initials: L
authors.lastname: Barrios
authors.forename: Benjamin
authors.initials: B
authors.lastname: Schneider
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Jones
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D050110:Bariatric Surgery; D015992:Body Mass Index; D005500:Follow-Up Studies; D006801:Humans; D019458:Insurance Coverage / Q000191:economics; D008875:Middle Aged; D009767:Obesity, Morbid / Q000191:economics / Q000628:therapy*; D018579:Patient Selection; D016079:Refusal to Treat / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D015431:Weight Loss; D055815:Young Adult