Why bariatric surgery wait times have nearly doubled in 10 years...

[Missouri-Lee's Summit 1,256]

So why do patients face longer wait times to receive bariatric surgery compared with surgeries to treat other life-threatening conditions such as cancer and heart disease?

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One big reason: Many insurance companies (including Medicaid) require those seeking bariatric surgery to lose weight before their surgery, even though there's no data or evidence to prove preoperative weight loss affects long-term success.

Patients with complex medical histories enrolled in Medicaid experienced the longest delays. Nonwhite patients also waited longer...

Smokers and patients with high cholesterol or psychological disorders also had longer wait times for bariatric surgery.

https://www.sciencedaily.com/releases/2018/07/180730090141.htm

How long did it take before you had your surgery? How long did you wait calculated from your first visit to your date of surgery? What requirements or obstacles did your insurance carrier impose? Supervised weight loss attempts? Were you told that you had to lose weight during those attempts… and that any weight gain would impede your path to surgery? Did you have to meet with a psychologist, nutritionist, and attend required bariatric surgery classes before your surgery was submitted to your insurance for surgery approval?

For those who were self-pay… did you circumvent your insurance carrier because of the obstacles/delays imposed by your carrier, because your BMI or other insurance mandated requirements did not make you “eligible” or because you had no bariatric benefits?

Edited August 19, 2018 by Missouri-Lee's Summit

[ChaosUnlimited 559]

My insurance required a 6 month supervised diet program, had to have frequent phone check-ins with one of their nurses to assess my readiness during that 6 months, and it required me to choose a "certified" program - which has nothing to do with an actual professional organization certification, it's the insurances own certification program that the practice has to apply for.

I was so frustrated, I had to choose a program that was over 70 miles from my home rather than my local hospitals program which is <10 miles from my home. I had, like most everyone else, considered the option of surgery for a long time, and when I finally made up my mind, I wanted to do it sooner rather than later and I was devastated to find out I had to wait 6 months, even though I had been seeing my primary doctor for weight loss pills for months, and I had documented weight loss and gains over the years.

Now, in retrospect, these requirements turned out to be the best thing that could have happened for me, with the exclusion of the insurance nurse phone calls - I didn't feel like I got any benefit from that.

I am so happy with my surgeon and my practice, I just can't speak highly enough about their care, their program, and the hospital they use. I had the option of the duodenal switch surgery at this practice, which I am very happy with, and would not have had that option at my local hospital. And I feel like I was very well prepared for the surgery and the changes that come with it during that 6 months in which my surgeon required educational classes and follow up with their team of nutritionists. I'm not sure I would have adjusted as well to the lifestyle changes without that time of preparation, education, and support from their team.

Having talked to others who participated in different programs for bariatric surgery, it seems like they didn't get nearly the amount of education for post-surgery that my program requires. Some have already started re-gaining weight after 1-2 years, which I can't predict if it will happen to me, but I feel like I still have an open line of communication with my practice and a lot of support when I have questions or issues. I often wonder when I see people posting about "cheating" on their plan within mere weeks or months of their surgery what their programs preparation requirements were and if it has any correlation to post op outcomes like compliance with diet. (This statement is not directed at anyone, it seems like these types of posts are fairly frequent here, and I'm not judging, but truly wondering if an intense preparation period makes a difference in outcomes)

[Orchids&Dragons 9,046]

My experience was almost identical to @ChaosUnlimited's except for the nurse phone calls. I thought our therapist and nutritionist were excellent and well-versed with bariatric issues. So, like Chaos, I thought I was well-prepared for what came after surgery. Yes, I wanted surgery sooner, but I think I benefitted from the delay.

[MIZ60 1,291]

My program required clearance from cardiology, psychology and attendance at 3 group classes as well as a one-on-one meeting with the nutritionist. I saw the surgeon for the first time on 12/26 and the longest wait was for the nutritionist (3 months)...they have since hired a second nutritionist. I finished everything in early April and was offered a date mid April but wanted to take a trip with my husband for his birthday and did not want to be on a preop diet during that time. Had surgery 5/2 and I was lucky that my insurance covered it 100%. There was no weight loss requirements but I was encouraged to start making changes in my diet which I did. I only lost about 6 pounds before I started the preop diet.

[summerset 5,261]

1 hour ago, ChaosUnlimited said:

Having talked to others who participated in different programs for bariatric surgery, it seems like they didn't get nearly the amount of education for post-surgery that my program requires.

You can have a very intensive and/or effective preparation within a few weeks. Just because a course is stretched out over many months doesn't mean more useful information is handed out to the patient.

When looking at the article the OP refers to there doesn't seem to be a correlation between success and the oh-so-holy waiting time.

Quote

Some have already started re-gaining weight after 1-2 years, which I can't predict if it will happen to me, but I feel like I still have an open line of communication with my practice and a lot of support when I have questions or issues.

You can have an open line and good support despite a short waiting period and if waiting time is that effective - shouldn't there be a really strong correlation between success and waiting time?

Is there any evidence that all the regainers had shorter waiting periods and less requirements to fulfill?

Quote

I often wonder when I see people posting about "cheating" on their plan within mere weeks or months of their surgery what their programs preparation requirements were and if it has any correlation to post op outcomes like compliance with diet.

Yeah, maybe they already burnt themselves out on strict pre-op programs.

SCNR. I think there will always be patients that will "fail", some in the short run, some in the longer run. With every medical or surgical therapy there are well-responders, not-so-well-responders and non-responders.

However, this seems to be something that a lot of people have a hard time wrapping their brains around. While it seems to be completely reasonable that any given pill that someone has to take for e. g. pain or high blood pressure or an antidepressant will get different results in different people (some get more symptom relief, some less) it seems to be that with WLS everyone can (dare I say must?) reach a normal BMI, otherwise he/she is a failure and to be blamed.

In that sense, patients who had WLS treat the procedure like they used to treat a diet in the past: if this doesn't work out 100%, it's my fault alone!

IMO this is a dangerous double edged sword. On the one hand it gives patients a feeling of power over the outcome (and after all we are not powerless), on the other hand when goal is not reached, the emotional consequences are all too often devastating.

Given the fact that patients respond differently to WLS, this "patient blaming" (that seems to be the worst within the WLS community) leaves a very foul taste in my mouth.

[Frustr8 7,886]

It's run as a money-making entity, not as a service and way to help people out of the pit of obesity and keep them from the slick slippery slopes of weight management lifelong.

[ChaosUnlimited 559]

13 minutes ago, summerset said:

You can have a very intensive and/or effective preparation within a few weeks. Just because a course is stretched out over many months doesn't mean more useful information is handed out to the patient.

When looking at the article the OP refers to there doesn't seem to be a correlation between success and the oh-so-holy waiting time.

You can have an open line and good support despite a short waiting period and if waiting time is that effective - shouldn't there be a really strong correlation between success and waiting time?

Is there any evidence that all the regainers had shorter waiting periods and less requirements to fulfill?

Yeah, maybe they already burnt themselves out on strict pre-op programs.

SCNR. I think there will always be patients that will "fail", some in the short run, some in the longer run. With every medical or surgical therapy there are well-responders, not-so-well-responders and non-responders.

However, this seems to be something that a lot of people have a hard time wrapping their brains around. While it seems to be completely reasonable that any given pill that someone has to take for e. g. pain or high blood pressure or an antidepressant will get different results in different people (some get more symptom relief, some less) it seems to be that with WLS everyone can (dare I say must?) reach a normal BMI, otherwise he/she is a failure and to be blamed.

In that sense, patients who had WLS treat the procedure like they used to treat a diet in the past: if this doesn't work out 100%, it's my fault alone!

IMO this is a dangerous double edged sword. On the one hand it gives patients a feeling of power over the outcome (and after all we are not powerless), on the other hand when goal is not reached, the emotional consequences are all too often devastating.

Given the fact that patients respond differently to WLS, this "patient blaming" (that seems to be the worst within the WLS community) leaves a very foul taste in my mouth.

You make good and valid points. I don't think the info itself is more useful because it's given out over a period of time, but I do think that stretching out the education over a longer period of time gives opportunity to integrate new eating habits into ones lifestyle before having to take the plunge after surgery. That might not be the case for everyone, but in retrospect, I think it softened the blow for me, although I couldn't see it at the time because I wanted to begin my post surgery journey asap.

I'm sure for the insurance companies waiting times are all about the cost analysis rather than for anyone's actual well-being.

Admittedly my post went on a side tangent compared to the topic of the article, I know six other people through work and other areas who have had surgeries at different practices and we've compared notes and discussed some of these topics. I don't know if there is actual correlation between re-gain and shorter wait times or less educational requirements, because I'm just going by the experiences of myself and a few people I know, but I was wondering aloud in my post because I think it would be interesting to look into.

Side tangent again: We've all seen that there is no consistency in pre-op diet, post-op diet and some other requirements between different surgical practices. The means to me that there is no evidence based method that defines how to achieve the best success overall of getting to and maintaining a more healthful weight or BMI. I have wondered if this has not been looked at more closely because it is still considered an elective procedure rather than a life saving or life extending procedure.

I hope you don't think that I was placing blame on people who have regain, because I assure you I was not. I am not even sure whether or not I will fall into that category in the long term. I just wonder if there are practices that can be looked at to help increase the chance of success, which we all want to achieve, however we each define it.

[summerset 5,261]

5 minutes ago, ChaosUnlimited said:

Side tangent again: We've all seen that there is no consistency in pre-op diet, post-op diet and some other requirements between different surgical practices. The means to me that there is no evidence based method that defines how to achieve the best success overall of getting to and maintaining a more healthful weight or BMI.

Maybe there is none. When it comes to exercise and nutrition and lifestyle in general, people are all too different with different wants and needs. Not everybody wants to make "losing and maintaining weight" a full time job on top of every else going on in life.

Quote

I have wondered if this has not been looked at more closely because it is still considered an elective procedure rather than a life saving or life extending procedure.

Interesting thought.

Quote

I just wonder if there are practices that can be looked at to help increase the chance of success, which we all want to achieve, however we each define it.

I'm not sure if this is possible. I'd say the best shot is to aim early for a maintainable lifestyle but in the end that is only another opinion as well.

[Missouri-Lee's Summit 1,256]

I narrowed my decision to two programs. One at a larger hospital with a very structured in-house program that required participants to use their nutritionist, physiologist etc. The other program had no structure. It offered a list of possible nutritionists and psychologists to contact for pre-op evaluation. You were basically on your own in deciding what to do. The only requirement the second program had was attending a one-hour talk about bariatric surgery and nutrition with a Q&A afterward. It was very basic information and a waste of time to attend.

I chose the second program. I don't like hovering professionals telling me what to do. I dislike rules and oversight and heavy-handed regimes. When I was told that I "had to" use their nutritionist (that the nutritionist I had already seen wasn't acceptable for their program), I knew that they would be sticklers every step of the way. I know some people thrive on structure and feel safe and cozy being told what to do and what not to do. I can't function that way. Even if it's for my own good, I don't like the idea of someone monitoring my behavior. While I feel as though I was tossed out on the curb sometimes, I'm doing okay. I have my primary doctor. I have my own kids (a pharmacist and two medical doctors) to look out for me, and I have myself. I'm not a clueless person waiting to be told what to do next or what I shouldn't be doing. If I ever find myself in a position in which I need help, I know how to ask for it. I just don't want "help" imposed on me. Does any of this resonate with anyone?