Natural history and metabolic consequences of morbid obesity for patients denied coverage for bariatric surgery

Ayman B. Al Harakeh, Kyle J. Burkhamer, Kara J. Kallies, Michelle A. Mathiason

Research output: Contribution to journalArticlepeer-review

30 Scopus citations


Background Patients satisfying the National Institutes of Health criteria and deemed appropriate candidates often do not undergo bariatric surgery for insurance-related reasons. Our objective was to explore the natural history of these patients compared with that of those who underwent laparoscopic Roux-en-Y gastric bypass (LRYGB). Methods The medical records of the patients evaluated for LRYGB from 2001 to 2007 were retrospectively reviewed. The presence of co-morbidities was assessed at the initial evaluation and within a 3-year follow-up period for patients who had undergone LRYGB and those denied surgery. The statistical analysis included chi-square tests. Results A total of 189 patients were in the denied cohort and 587 in the LRYGB cohort. The age, gender, and body mass index were similar between the 2 cohorts at the initial evaluation. The percentage of patients with a diagnosis of a co-morbidity in the denied and LRYGB cohorts at the initial evaluation was 20% and 25% with diabetes mellitus, 51% and 43% with hypertension, 20% and 22% with obstructive sleep apnea, 34% and 24% with lipid disorders, and 62% and 49% with gastroesophageal reflux disease, respectively. The body mass index at the initial evaluation and during follow-up was 47.3 and 46.8 kg/m2 in the denied cohort (n = 165, P = .236) and 48.5 and 30.5 kg/m2 in the LRYGB cohort (n = 544, P <.001), respectively. During the follow-up period, a greater incidence of new-onset diabetes (P <.001), hypertension (P <.001), obstructive sleep apnea (P <.001), gastroesophageal reflux disease (P <.001), and lipid disorders (P <.001) was observed in the denied cohort. Conclusion Patients denied LRYGB had a greater incidence of new co-morbidities diagnosed within a short follow-up period, without a significant change in their body mass index.

Original languageEnglish (US)
Pages (from-to)591-596
Number of pages6
JournalSurgery for Obesity and Related Diseases
Issue number6
StatePublished - Nov 2010

Bibliographical note

Funding Information:
The authors receive fellowship grant support from Covidien. Dr. Kothari serves as a consultant for Covidien, Valleylab, and LifeCell.


  • Co-morbidities
  • Denial
  • Insurance
  • Laparoscopic gastric bypass
  • Morbid obesity


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