medically supervised weight loss program FAILURE???

Medical therapy prior to surgery

One bariatric surgery group wrote that it favored bariatric surgery for those over age 65 and standardized facility criteria, but believed that a medical treatment weight loss trial for 6 to 12 months was not necessary. They commented that the decision of when to perform surgery was best left to the surgeon and the patient.

Generally, a common comment introduced pertained to the subjective nature of the medical treatment requirement prior to surgery. Some stated that there were no data to support such a requirement and others stated that the requirement only prolonged the time to needed surgery.

The standard of care for any surgical procedure is that medical management options are exhaustively considered and exercised by both patient and physician prior to surgery. This standard applies to the treatment of co-morbid conditions related to obesity. We will not impose a specific time period, but expect all surgeons to be part of a comprehensive program for the treatment of co-morbid conditions related to obesity and to have applied principles of good medical care prior to surgery.


If it's good enough for Medicare patients, then why not for those of us who have to pay for our insurance out of pocket. Maybe if more people appeal this requirement and won insurance companies would take it out of their medical policies. We can hope anyhow. 

If your insurance company requires the 6 month diet and there isn't a state agency like the DMHC you can go to in your state just do the best you can on the diet. No one says you have to actually diet, just go every month to your PCP and tell them what they want to hear. They can'****ch over you to make sure you're doing it. And like you say it is total BS that they require the diet at all; WLS is a last resort for those of us who are MO or SMO no one wants their insides cut up and rerouted if we could lose weight on our own. Best of luck to you


PS here is the link for the DMHC peer review stating that the medically supervised diet is not necessary. Maybe you can appeal using Medicare and the CA DMHC as examples and see what your insurance says. All they can say is no and then you'll still have started your diet anyhow. Just a thought.

http://www.dmhc.ca.gov/aboutTheDMHC/org/boards/cap/Bariatric REV.pdf
SUMMARY CONCLUSION
There is no literature presented by any authority that mandated weight loss, once a patient   has
been identified as a candidate for bariatric surgery, is indicated. There is a mixture of results that
question whether weight or truncal obesity is a risk factor for complications after bariatric
surgery. The more analytic studies have not found that body mass index (BMI) or total weight is
an independent risk factor for complications or death from bariatric surgery.
No institution that has recently published data on bariatric surgery describes a protocol requiring
weight loss between identification of the need for surgery and the surgery. Many institutions in
California have published results of surgery with particular focus on factors that contribute to
morbidity and mortality. No paper from a California institution mentions mandated weight loss
before bariatric surgery. Nor does any literature regarding the treatment for the morbidly obese
recommend continued weight loss during the period between identification of the need for
bariatric surgery and the surgery.
Mandated weight loss prior to indicated bariatric surgery is without evidence-based support.
Mandated weight loss prior to indicated bariatric surgery leaves the patient at increased risk from
the patient’s comorbidities. Mandated weight loss prior to indicated bariatric surgery is not
medically necessary. Mandated weight loss prior to indicated bariatric surgery would be deviant
from the standard of care practiced in the United States and other published countries. The risks
of delaying bariatric surgery, while not entirely known in the short-term, are real and can be
measured. Any potential value of losing weight prior to bariatric surgery is theoretical and not
supported by any data. An experimental study including fully informed consent to determine if
there were a reduction in risks or other benefit from mandated weight loss prior to bariatric
surgery is indicated.