Waiting period for weight-loss surgery is useless, study says

People who are slated to undergo weight-loss surgery are often required by their health insurance company to wait six months from the time of approval to the time of surgery. The wisdom behind the waiting period is that patients should use the time to try to adapt to new diet and exercise habits that will be essential to their long-term success.

A study presented Saturday at the annual meeting of the American Society for Metabolic & Bariatric Surgery suggests that the waiting period is ineffective. Researchers followed 440 people who had either laparoscopic gastric bypass or laparoscopic adjustable gastric banding. Of these, 116 people were required by their health insurance plan to wait six months. The study showed there was no significant difference between the two groups in weight loss prior to surgery or one year after surgery.

According to the study's author, Dr. Timothy Kuwada of the Carolinas Medical Center in Charlotte, N.C., typically all patients receive nutritional and psychological counseling about their post-surgical lifestyle in advance of the surgery. That approach is sufficient, he suggests. However, given the cost of surgery and the importance of lifestyle changes to success, it doesn't seem unreasonable for insurers to ask that patients prepare for the surgery and its aftermath -- whether that takes one month or six.

In another study presented Saturday at the meeting, researchers found that gastric bypass surgery restored levels of low-density lipoprotein -- or bad -- cholesterol to normal in 91% of patients within six months of the surgery and that these patients remained off medication six years later. Also, six years after the surgery, levels of HDL, or good, cholesterol, had increased by more than 10%. The study was conducted at the University of Iowa Hospital and Clinics.

-- Shari Roan

Photo credit: Karen Tapia-Andersen / Los Angeles Times

Comments

[Julia Ziobro]

This is not a surprising result to me. The insurance company will claim one set of reasons for inserting the delay into the process, but I think there's actually a different reason.

Insurance-company reason: Requiring a waiting period flushes out people who are not serious and committed to having the surgery done. Those who are going to change their minds will probably do so during that time period, and if they're being pressured by someone else to do the surgery, this time might let that dynamic sort itself out. (It sounds plausible, but in the hundreds of weight-loss surgery pre-ops and patients I've known, I can think of two cases where it actually applied).

The real reasons: Six months of premiums adds up to a slight recovery of the expense of the surgery. Six months is time that the insurance company might be able to find a way to risk you off your policy, increase your premiums pre-emptively, or literally wait for the fat person to die and then no longer need surgery. Again, out of hundreds of pre-ops and patients I've known, I can think of about 20 that lost their insurance thanks to actions of the insurance company, 25 or so that lost or changed jobs and lost coverage for their surgery, about 30 that had huge premium increases before their surgery, and 3 that died waiting for surgery. It is all about the money for insurers.

I had my surgery done in 2001 (before it was trendy) and after years of every medically-supervised diet and exercise plan you've ever heard of had helped me balloon to 312 lbs. After almost 9 years, I am still down 160 lbs to a normal BMI and healthy in general. I'm very glad I had the surgery, though it has not always been easy to live with.

[Nurse Rachet]

Whatever happened to self control? The majority of these morbidly obese people would fare better by pushing back from the table. This is one of the MANY reasons health care costs so much.
Americans take NO RESPONSIBILITY for themselves and their own well being. They just show up on some health care provider's doorstep when it reaches a crisis point. Wake up people! Stop being so lazy, fat and stupid...take care of you body, and it will not betray you.

The same goes for smoking. That is just plain STUPID and shows a total lack of self control!

[Common Sense]

The American Society for Metabolic & Bariatric Surgery has the sole mission of promoting metabolic & bariatric surgery. This is no different than any other interest group opposing any other sort of government regulation. Nothing to see here...

[IceAmericano]

The purpose of the six month waiting period is to reduce the number of people who get the benefit, pure and simple. The insurance companies want to discourage people, put up obstacles and set criteria that they can fail to meet so that they don't have to pay for the coverage. Then they want to deny people health coverage because they are obese and blame rising costs on obesity. Catch-22 for people, more $$ for insurance companies.

[Yeah Right]

Wow. I'm glad Nurse Rachet isn't my nurse. She must be one of those ultraskinny people who hates tasty food and doesn't ever have any addictions to anything. Clearly the nicotine in cigarettes, a known addictant, has nothing to do with people smoking.

She must spend her whole life lecturing other people on how bad they are. I guess that sort of lifestyle means you're perfect.

[Jere Krischel]

If they had demanded that the patients restrict carbohydrates for 6 months before getting surgery, the would've seen much less need for the surgery in the first place. Simply waiting and listening to the same failed "low-fat/low-calorie/exercise" advice isn't going to change anything. Understanding that carbohydrates are the key to weight regulation because of their effect on insulin will change things.

I'm appalled that we live in a society that promotes the eating of cereals and grains and other damaging carbohydrates, while it denigrates healthy fat, protein and salt. To think that we require surgery to cope with the damage that carbohydrate does to our health is mind boggling.

[Sara]

Hating fat people, as Nurse Ratchet's comment blatantly suggests, is not acceptable. Obesity is not a matter of self control or willpower, as Ratchet suggests and appears to believe. To believe that obesity is a matter of self control or lack of will power is oversimplification of the problem. Obesity surgery is a tool to help those who are severely overweight, to obtain control over how much they eat, but it is not magic. To think that obesity surgery is magical is a falsehood that is perpetuated by the media outlets promising people weight loss with little or no effort, but it is hard work, about making better choices and overcoming the emotional or physiological issues that draw people to food as a means of comfort or satisfaction. To anyone believing that being fat is a choice, you are wrong and you have obviously never been fat, because nobody would choose to be mistreated or demeaned by society.
Before you think it is acceptable to be rude or judgmental to a person that does not fit society's definition of health or fitness, think twice, because it could one day be you that is trapped in your own body.

Oh and a final distinction related to a comment that Nurse Ratchet made- smoking is not the same as eating; smoking is not required to live, but eating food, in some form, is. I pity the ignorance of Nurse Ratchet and those like him/her.

[Ashley]

Wow - I had no idea it was such a wait to get the surgery! I think that is great though - adjusting to a whole new diet and health regimen is not easy! Giving someone 6 months to make the right changes in their life is worth rewarding them with this surgery if they are working towards it!

[trish]

hi i had gastric bypass surgery five years ago and did not keep up the medications prescribed to me by my specialist,consequently i now have low vitamin ,iron,calcium ,folic acid and vitamin b12 levels but have started to take the medications for these problems. I have also been diagnosed as having Hypothyroidism and am taking Eltroxine. I have a problem digesting red meats and believe the iron defiecency comes from this. It has been suggested i take a hydrochloric acid supplement and also pepsin, any comments on this?