Systematic Review and Meta-Analysis of the Effectiveness of Insurance Requirements for Supervised Weight Loss Prior to Bariatric Surgery

Many insurance plans impose strict criteria mandating preoperative weight loss attempts to limit patient's access to surgery. Preoperative acute weight loss has been hypothesized to reduce perioperative risk and to identify compliant patients who may have improved long-term weight loss. In this review, the evidence from studies examining clinical and weight loss outcomes both with and without preoperative weight loss are summarized. Although preoperative weight loss may have modest impact on some factors related to perioperative conduct, the evidence does not support these programs' effectiveness at promoting long-term weight loss. Provision of weight loss surgery should not be contingent on completion of insurance-mandated weight loss goals preoperatively, and these programs may, through patient attrition, actually do more harm than good.