Original article
Insurance-mandated preoperative dietary counseling does not improve outcome and increases dropout rates in patients considering gastric bypass surgery for morbid obesity

Presented at the 22nd Annual Meeting of the American Society for Bariatric Surgery, Orlando, Florida, June 26–July 1, 2005.
https://doi.org/10.1016/j.soard.2006.01.009Get rights and content

Abstract

Background

Preoperative dietary counseling (PDC) before bariatric surgery is mandated by a growing number of insurance payers. Their claim is that PDC improves outcomes and postoperative compliance. We compared outcomes of GBP patients undergoing a mandatory 13 weeks of PDC (n = 72) to a contemporaneous group of patients with no such requirement (no-PDC; n = 252) who underwent operation between January 2000 and December 2002.

Methods

The PDC and no-PDC groups were characterized by similar male:female ratios (1:4 vs 1:4.6), mean age (42 years), mean body weight (324 lb vs 309 lb), and mean body mass index (BMI) (52 kg/m2 vs 50 kg/m2). The PDC group had a higher incidence of obstructive sleep apnea compared with the no-PDC group (41% vs 28%; P < .04) but otherwise the two groups had similar incidences of obesity-related comorbidities. The presurgery dropout rate was 50% higher in the PDC group than in the no-PDC group (28% vs 19%; P < .05).

Results

At 1 year follow-up, the no-PDC patients had a statistically greater percentage excess weight loss (67% vs 60%; P < .0001), lower BMI (32 vs 35; P < .015), and lower body weight (197 vs 218; P < .01). Resolution of major comorbidities, complication rates, 30-day postoperative mortality, and postoperative compliance with follow-up were similar in the two groups.

Conclusions

The data demonstrate that insurance-mandated PDC is an obstacle to patient access for surgical treatment of severe obesity and has no impact on weight loss outcome or postsurgical compliance. PDC should be abandoned by the insurance industry.

Section snippets

Methods

The database of 324 patients who underwent either an open or laparoscopic GBP procedure at the Virginia Commonwealth University from January 2000 to December 2002 was prospectively analyzed for clinical outcomes. The analysis included patients undergoing a primary GBP procedure; all revisions and conversions from a previous bariatric procedure to a GBP were excluded. This information was prospectively maintained and updated based on patients’ clinic and hospital charts. A follow-up period of at

Results

The demographic characteristics of the study population are given in Table 1. The PDC group had a higher number of male patients, higher BMI, and greater overall TBW compared with the no-PDC group, although these differences between groups were not statistically significant. A total of 238 patients underwent LGBP (188 of 252 patients in the no-PDC group [64.6%] and 50 of 72 in the PDC group [69.4%]; P = .45) and 86 underwent OGBP. Three deaths occurred after GBP surgery (one after LGBP and two

Discussion

The present study compared two groups of morbidly obese patients, one of which underwent insurance-mandated PDC before GBP. All patients studied qualified for this procedure based on the National Institutes of Health Consensus Criteria. We sought to determine whether PDC improves surgical outcomes in this select group of patients. Our findings suggest that PDC does not necessarily improve postoperative weight loss or complication rates.

Few studies have evaluated the feasibility of PDC before

References (16)

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