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Obesity Week 2013

Private patients lose more weight than government patients

Greater weight loss despite longer insurance-mandated medically supervised diet programme before surgery
Kimberly S Maloomian

The biggest determinant of weight loss after bariatric surgery was not how long a patient was on a medically supervised diet program before surgery, but whether or not the patient had private or government-subsidised insurance, claim researchers from the Miriam Hospital in Providence, RI, and Alpert Medical School at Brown University. The research was presented at the 30th Annual Meeting for the American Society for Metabolic and Bariatric Surgery (ASMBS) during ObesityWeek 2013, the largest international event focused on the basic science, clinical application and prevention and treatment of obesity. The event was hosted by the ASMBS and The Obesity Society (TOS).

“Our study does not support pre-operative medical supervised diet programs for longer durations than three months,” said Dr Kimberly S Maloomian, at The Miriam Hospital. “Rather than insurers requiring diet programmes that make very little difference in weight loss after surgery and increasing the amount of health care dollars spent per patient, clinicians should be allowed to use their professional judgment preoperatively, and provide individualised education to patients on a case by case basis.”

The retrospective study followed 300 bariatric surgery patients in Rhode Island for three years. Three months after surgery all patients had similar weight loss, but six months after surgery, those on private insurance plans lost more than 30 percent more total weight than those on government-subsidised health plans (70 pounds vs. 55 pounds), regardless of their time on pre-operative doctor supervised diet programs.

All the government-subsidized health plans in the study (Neighborhood Health Plan of Rhode Island, Rhody Health Partners and RIte Care; Medicare and Medicaid patients were excluded due to lack of a requirement) required patients to be on a medically supervised diet for four to six months, while private insurers required either three months or six months. Privately insured patients on the three-month diet program lost about 70lbs after surgery, about the same weight loss experienced by privately insured patients on six-month diet plans. However, patients in government-subsidised health plans, who were all required to be on pre-operative diet plans for four to six months, lost 55.5lbs.

In terms of excess weight loss after surgery, privately insured patients on the six month plans lost 53 percent six months after surgery; excess weight loss among privately insured patients in the three month plans was 36.9 percent and government-subsidized patients lost 37 percent.

Prior to starting any of the pre-operative diet programmes, the three groups were similar in regards to weight, BMI, and presence of co-morbidities. Patients weighed between 284 and 299lbs and BMIs were between 46.5 and 48.2. Weight loss from the pre-operative diet programmes was minimal. The government-backed insurance patients gained a little more than a pound. Patients on the three-month programmes experienced negligible weight loss and privately insured patients on the six-month plan lost less than four pounds.

The study also found the government-subsidised health plan patients were more likely to drop out of bariatric surgery programmes during the pre-operative period than privately insured patients (18% vs. 14% of privately insured patients in the six month group). Privately insured patients with a three month requirement had a 6.5 percent dropout rate.

“As we move to a non-fee for service health care model, we need to be careful about how we spend our patients’ health care dollars,” added Maloomian. “The pre-operative focus should be on helping to prepare patients for adherence to nutrition and activity recommendations after surgery, since it is in the post-surgical period where we can have the greatest impact on outcomes. Once the clinician feels the patient is ready, he or she should be cleared for surgery, not be required to come for more visits, which unnecessarily spends more time and money."

The researchers conclude that the study does not support preoperative MSWL for longer durations than three months, based on preop and post-operative weight loss data regardless of insurers. Although they acknowledge that further analysis is needed to evaluate the suboptimal weight loss in government-funded patients such as the barriers to weight loss and access to food and/or exercise and nutritional awareness education.

To access the posters and abstracts from Obesity Week, please click here

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American Society for Metabolic and Bariatric Surgery

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