title: Insurance-mandated medical programs before bariatric surgery: do good things come to those who wait?
abstract: BACKGROUND
  Insurance companies often require a mandated medical program (MMP) before bariatric surgery. It is unknown whether MMPs improve weight loss before and after surgery. The purpose of our study was to determine whether MMPs improve pre- and postoperative weight loss at a tertiary care, U.S. academic teaching hospital.
  
  
  METHODS
  After institutional review board approval, data were collected prospectively from consecutive patients undergoing nonrevisional laparoscopic gastric bypass or adjustable gastric banding from August 2006 to 2010 by a single surgeon (T.S.K.). The patients were divided into 2 groups: those undergoing a MMP and those who did not. The MMP patients underwent a standardized program of ≥6 months' duration under the direction of our medical bariatricians and nutritionists. The data from the laparoscopic gastric bypass and laparoscopic adjustable gastric banding patients were analyzed separately. The primary outcome data included the interval to surgery and the percentage of excess weight loss before surgery and at 6 and 12 months after surgery.
  
  
  RESULTS
  A total of 440 patients (327 laparoscopic gastric bypass and 113 laparoscopic adjustable gastric banding) were included in the present study. No significant difference was found in the preoperative percentage of excess weight loss or the percentage of excess weight loss at 6 and 12 months after surgery between the MMP and non-MMP patients. The MMP patients had a significantly longer wait time to surgery.
  
  
  CONCLUSIONS
  Patients who underwent a standardized MMP had a significant delay in their time to surgery and did not experience significant benefit in their preoperative or postoperative weight loss. Insurance companies should abandon the policy of mandating preoperative medical weight loss programs.
authors.affiliation: Section of Bariatric Surgery, Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina, USA. tim.kuwada@carolinas.org
authors.forename: Timothy S
authors.initials: TS
authors.lastname: Kuwada
authors.forename: Sarah
authors.initials: S
authors.lastname: Richardson
authors.forename: Maher
authors.initials: M
authors.lastname: El Chaar
authors.forename: H James
authors.initials: HJ
authors.lastname: Norton
authors.forename: John
authors.initials: J
authors.lastname: Cleek
authors.forename: John
authors.initials: J
authors.lastname: Tomcho
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Stefanidis
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000379:methods*; D005260:Female; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D011446:Prospective Studies; D016896:Treatment Outcome; D015431:Weight Loss