Interqual guidelines for surgery

Anyone heard of this? Seems to be what my insurance company uses to determine if it is necessary, and they sent me a list of the requirements, but there isn't a lot of detail. For instance, says "documentation of failed weight loss management attempts". But there is no explanation of what that means. 

Something like a record of your weight loss attempts with Weigh****chers..something documented to show you have attempted weight loss before.