title: Insurance-mandated medical weight management before bariatric surgery.
abstract: BACKGROUND
  Many insurance companies require a medical weight management (MWM) program as a prerequisite for approval for bariatric surgery. There is debate regarding the benefit of this requirement. The objective of this study is to assess the effect of insurance-mandated MWM programs on weight loss outcomes in our bariatric surgery population.
  
  
  OBJECTIVE
  To assess the effect of insurance-mandated MWM programs on weight loss outcomes in our bariatric surgery population.
  
  
  METHODS
  University.
  
  
  METHODS
  A retrospective review of all bariatric surgery cases performed between 2009 and 2013 was conducted. Patients were stratified by payor mix based on whether the insurance company required MWM. To control for differences between groups, a bucket matching algorithm was used to match patients based on gender, age, body mass index (BMI), and surgery type (sleeve gastrectomy, gastric bypass, or gastric band). A repeated-measures regression model was created to estimate percent excess weight loss, percent excess BMI loss, and percent total weight loss.
  
  
  RESULTS
  A total of 1432 bariatric surgery patients were reviewed. The bucket-matching algorithm resulted in 560 patients for final analysis. Mean age and BMI were 41 years and 43 kg/m(2), respectively, and 91% were female. The regression model found no significant differences in weight loss outcomes between the MWM group and the comparison group at 1 year and 2 years-percent total weight loss: 21.3% [95% confidence interval [CI] 20.6%-22.1%] versus 20.2% [95%CI 19.7%-20.6%) at 1 year and 23.4% [95%CI 22.6%-24.3%] versus 21.5% [95%CI 21.0%-22.0%] at 2 years.
  
  
  CONCLUSIONS
  There was no difference in weight loss outcomes up to 2 years in patients who required insurance-mandated MWM programs. Longer-term studies are needed to determine the benefit of this insurance requirement.
authors.affiliation: Department of Surgery, New York University Langone Medical Center, Bellevue Hospital Center, New York, New York.
authors.forename: Daniel
authors.initials: D
authors.lastname: Horwitz
authors.affiliation: Department of Surgery, New York University Langone Medical Center, Bellevue Hospital Center, New York, New York.
authors.forename: John K
authors.initials: JK
authors.lastname: Saunders
authors.affiliation: Department of Surgery, New York University Langone Medical Center, Bellevue Hospital Center, New York, New York.
authors.forename: Akuezunkpa
authors.initials: A
authors.lastname: Ude-Welcome
authors.affiliation: Department of Surgery, New York University Langone Medical Center, Bellevue Hospital Center, New York, New York. Electronic address: manish.parikh@nyumc.org.
authors.forename: Manish
authors.initials: M
authors.lastname: Parikh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D050110:Bariatric Surgery / Q000191:economics*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000191:economics / Q000628:therapy*; D011300:Preoperative Care / Q000191:economics; D012189:Retrospective Studies; D016896:Treatment Outcome; D015431:Weight Loss; D055815:Young Adult
keywords: Bariatric surgery; Insurance; Mandate; Medical weight management