key: cord-349206-f77ofx1w authors: Hutter, Matthew M.; Kothari, Shanu N.; LaMasters, Teresa L.; DeMaria, Eric J. title: Open Letter to Insurance Companies Regarding Mandatory in Office Visit Weight Documentation in an Era of COVID-19 date: 2020-05-26 journal: Surg Obes Relat Dis DOI: 10.1016/j.soard.2020.05.020 sha: doc_id: 349206 cord_uid: f77ofx1w nan To: Insurance Company, Medical Director During these unprecedented times with the COVID-19 pandemic, it has become clear that some 10 populations are at increased risk of severe illness, complications, and death once contracting the novel coronavirus. This is particularly the case for patients with obesity and type 2 diabetes. 1-5 Treatment of people with the disease of obesity and related disease is critical in the strategy to decrease risk of poor outcomes and death following COVID-19. Metabolic/bariatric surgery is the only proven, long-term, successful intervention for patients suffering from clinically 15 severe obesity. In addition, there are over 12 prospective, randomized trials showing the superiority of metabolic/bariatric surgery over optimal medical management for patients with type 2 diabetes. 6, 7 Increased morbidity and mortality due to coronavirus infection is only the newest of several hundred medical comorbid conditions caused or aggravated by obesity including some of the most serious diseases impacting our society today including type 2 20 diabetes, hypertension, heart disease, obesity-related cancers, etc. Currently there are multiple insurance-mandated barriers to care that are placed on people seeking treatment of severe obesity. One of these barriers relates to specific diet and weightrelated requirements. This typically includes regular in-office weight measurements and in some 25 2 cases the requirement for documentation of weight loss prior to receiving surgical treatment for the disease of obesity. Based on data from multiple studies that show no benefit to insurancemandated documentation of diet effort and/or weight loss prior to metabolic/bariatric surgery, as summarized by the ASMBS Clinical Issues Committee in our peer-reviewed publication from 2016 8 , we recommend immediate termination of all insurance-mandated diet and weight 30 related prerequisites for bariatric surgery including the excessive, burdensome, and potentially dangerous requirement for in-office weight documentation. These requirements not only have no scientific basis to support their existence, but they also create barriers to care. [9] [10] [11] [12] [13] [14] [15] [16] Furthermore, by requiring in-person visits to accomplish repeated weight checks, these requirements lead to unnecessary health care facility visits for some of our most 35 vulnerable patients, putting them at increased risk for exposure to, and transmission of, COVID- The best preoperative care and preparation for surgery is determined at the local level by the multidisciplinary team caring for their patients on the front lines. 8 Many healthcare providers and 40 patients are finding telehealth solutions in the current environment that allow for effective care without the risks incurred by in-office visits. In recent weeks, the U.S. health care system has been stressed to unprecedented levels as many healthcare providers have been reassigned, furloughed, or have lost their jobs. Adding 45 unnecessary in-person appointments and presurgical weight loss requirements will only stress the system further in a time of scarce resources. Consequently, we feel there is no better time than the present for health plans to use evidence-based recommendations and terminate these unsubstantiated discriminatory policies. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease Clinical Characteristics of Coronavirus Disease 2019 in China Obesity and COVID-19 severity in a designated hospital in Shenzhen COVID-19): 75 People who are at higher risk for severe illness Hospitalization rates and characteristics of patients hospitalized with laboratory-confirmed coronavirus disease 2019 -COVID-NET, 14 80 states Outcomes of Bariatric Surgery Versus Medical Management for Type 2 Diabetes Mellitus: a Meta-Analysis of Randomized Controlled Trials Surgical versus medical treatment of type 85 2 diabetes mellitus in nonseverely obese patients: a systematic review and metaanalysis American Society for Metabolic and Bariatric Surgery Clinical Issues Committee. ASMBS updated position statement on insurance 6 mandated preoperative weight loss requirements Number of weight loss attempts and maximum weight loss before Roux-en-Y laparoscopic gastric bypass surgery are not predictive of postoperative weight loss Insurance-mandated preoperative counseling does not improve outcome and increases dropout rate in patients considering gastric bypass for morbid obesity The natural history and metabolic consequences of morbid obesity for patients denied coverage for bariatric 100 surgery Insurance-mandated preoperative diet and outcomes after bariatric surgery Postoperative 105 outcomes in bariatric surgical patients participating in an insurance-mandated preoperative weight management program Evidence Base for Optimal Preoperative Preparation for Bariatric Surgery: Does Mandatory Weight Loss Make a Difference? Insurance-mandated medical 110 weight management before bariatric surgery Insurance-mandated medical programs before bariatric surgery: do good things come to those who wait? The authors have no conflicts of interest pertaining to this letter to disclose.