“Insurance-mandated medical weight management before bariatric surgery” by Manish Parikh, M.D. et al from the department of Surgery of New York University Langone Medical Center. This interesting study is published in the current issue of SOARD. It assesses the effect of insurance mandated medical weight loss programs on weight loss outcomes after bariatric surgery. A total of 1432 patients were analyzed retrospectively including a control group of 560 patients. There was no weight loss difference between both groups at one and 2 year follow up.

There is no doubt that patient education prior to bariatric surgery is crucial. Obesity is a lifestyle disease. Almost all patients I see in my practice presenting for gastric sleeve or bypass surgery consume junk and processed food on daily basis. They have no time to cook at home and very little time to exercise. They skip breakfast and eat heavy rich food at night. Many use food as a coping mechanism and are addicted to sugar in the form of soda, sweet tea or candies. Obviously, there is a role for education here. Some patients require one or two educational visits and others will never learn how to change their habits and lifestyle. Those who don’t learn or are not capable of changing their habits and daily living do not qualify for bariatric surgery even after they meet the insurance requirement for pre-operative medical weight loss.

This study proves that the insurance requirements are rigid, ineffective and not suitable for every patient. I would rather see the insurance companies create lifestyle programs that promote healthy eating and living. Through these programs patients are screened and referred to bariatric surgery if found appropriate. Bariatric surgery is currently the most effective treatment for obesity. It is a durable solution especially when patients adheres and adopts healthy eating and exercise habits. Gastric bypass and sleeve procedures save lives, resolve comorbidities and ultimately save money for both insurance companies and government. Insurance companies, public health officials and the federal government should work together to promote effective weight loss solutions and most importantly preventative measures to curb the obesity epidemic. Unfortunately, we are still dabbling with archaic rules and regulations that make no sense and are preventing qualified patients from getting the care they deserve.

Finally, I would like to emphasize the importance of post-operative follow up and supervised medical weight loss. Obesity is a chronic disease and weight loss is a lifetime battle. Bariatric surgery gives you the edge in this battle but you must keep fighting weight gain even after successful weight loss surgery.