Researchers Question Value Of Making Patients With Severe Obesity Wait Six Months Or More To Have Weight Loss Surgery

WASHINGTON, Nov. 1, 2017 /PRNewswire/ -- Patients are often required to lose weight over a period of six months or more before insurers approve bariatric surgery, but new research* suggests this requirement does nothing to improve weight loss after surgery. Six months after surgery, patients on average lost more than 25 percent of their body weight no matter how long they waited to have surgery.

Researchers from Stanford University School of Medicine presented their findings today at ObesityWeek™ 2017, the largest international event focused on the basic science, clinical application and prevention and treatment of obesity. The annual conference is hosted by the American Society for Metabolic and Bariatric Surgery (ASMBS) and The Obesity Society (TOS).

"The majority of patients seeking bariatric surgery are delayed or deterred from having surgery because of an arbitrary insurance requirement," said John M. Morton, MD, Chief, Bariatric and Minimally Invasive Surgery at Stanford School of Medicine. "Based on the evidence, these policies are not helping patients. In fact, it could be hurting them as medical problems may become worse and patients suffer unnecessarily. Mandated preoperative wait times should be re-evaluated with a greater emphasis given to goal directed, and not time-mandated preoperative weight loss."

The study analyzed the waiting periods of 427 patients undergoing laparoscopic Roux-en-Y gastric bypass (263), sleeve gastrectomy (152), or adjustable gastric banding (12) at Stanford University Medical Center between 2014 and 2015. The average time between the initial surgical consult and the actual surgery was nearly seven months, but was as little as seven days to as much as five years.

Researchers say about two-third of the patients in the study had to wait six months before surgery due to insurance requirements for pre-operative weight loss. However, patients lost little weight during this time. The average body mass index (BMI) went from 47 to 46. Once patients did have surgery, regardless of how long they had to wait for it, the average BMI dropped to about 35 – a 25 percent drop.

"We have to go where the evidence takes us, and there is no evidence supporting preoperative weight loss requirements without consideration of the individual patient, his or her severity of disease and the determination of his or her doctor," said Stacy Brethauer, MD, ASMBS President and associate professor of surgery specializing in advanced laparoscopy and bariatric surgery at the Cleveland Clinic in Ohio, who was not involved with the study.

In a 2016 position statement the ASMBS concluded, "insurance-mandated preoperative weight loss is not sup- ported by medical evidence and has not been shown to be effective for preoperative weight loss before bariatric surgery or to provide any benefit for bariatric outcomes.

Metabolic/bariatric surgery has been shown to be the most effective and long lasting treatment for severe obesity and many related conditions and results in significant weight loss.¹ The ASMBS estimates there were 216,000 bariatric surgeries performed in the U.S. last year. The Agency for Healthcare Research and Quality (AHRQ) reported significant improvements in the safety of metabolic/bariatric surgery due in large part to improved laparoscopic techniques.² The risk of death is about 0.1 percent³ and the overall likelihood of major complications is about 4 percent.⁴ According to a 2014 study from the Cleveland Clinic's Bariatric and Metabolic Institute, laparoscopic bariatric surgery has complication and mortality rates comparable to some of the safest and most commonly performed surgeries in the U.S., including gallbladder surgery, appendectomy and knee replacement.⁵

According to the National Center for Health Statistics, 39.8 percent of adults and 18.5 percent of children in the U.S. had obesity in 2015-2016, the highest rate ever for adults. Hispanic adults had an obesity rate of 47 percent and Non-Hispanic black adults a rate of 46.8 percent. Obese is medically defined as having a body mass index (BMI), a ratio of height to weight, of more than 30. The ASMBS estimates about 24 million Americans have severe obesity, which would mean a BMI of 35 or more with an obesity-related condition like diabetes or a BMI of 40 or more.

About the ASMBS
The ASMBS is the largest organization for bariatric surgeons in the nation. It is a non-profit organization that works to advance the art and science of bariatric surgery and is committed to educating medical professionals and the lay public about bariatric surgery as an option for the treatment of severe obesity, as well as the associated risks and benefits. It encourages its members to investigate and discover new advances in bariatric surgery, while maintaining a steady exchange of experiences and ideas that may lead to improved surgical outcomes for patients with severe obesity. For more information, visit www.asmbs.org.

*Pre-Operative Weight Loss: Is Waiting Longer Before Bariatric Surgery More Effective? (A124)
Victor Eng, BS, San Francisco, CA; Habib Khoury, BS, San Francisco, CA; John Morton, MD, MPH, FACS, Stanford, CA; Dan E. Azagury, MD, Stanford, CA -- all from Stanford University School of Medicine

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¹ Weiner, R. A., et al. (2010). Indications and principles of metabolic surgery. U.S. National Library of Medicine. 81(4) pp.379-394. https://www.ncbi.nlm.nih.gov/pubmed/20361370
² Encinosa, W. E., et al. (2009). Recent improvements in bariatric surgery outcomes. Medical Care. 47(5) pp. 531-535. Accessed October 2013 from http://www.ncbi.nlm.nih.gov/pubmed/19318997
³ Agency for Healthcare Research and Quality (AHRQ). (2007). Statistical Brief #23. Bariatric Surgery Utilization and Outcomes in 1998 and 2004. Accessed October 2013 from http://www.hcup-us.ahrq.gov/reports/statbriefs/sb23.jsp
⁴ Flum, D. R., et al. (2009). Perioperative safety in the longitudinal assessment of bariatric surgery. New England Journal of Medicine. 361 pp.445-454. Accessed October 2013 from http://content.nejm.org/cgi/content/full/361/5/445 
⁵ Gastric Bypass is as Safe as Commonly Performed Surgeries. Health Essentials. Cleveland Clinic. Nov. 6, 2014. Accessed October 2017 https://health.clevelandclinic.org/2014/11/gastric-bypass-is-as-safe-as-commonly-performed-surgeries/

SOURCE ASMBS