Unintended consequences: Study finds 40 percent mortality rate for patients denied bariatric surgery

• Researchers followed up with 107 patients initially denied weight-loss surgery in 2007
• By 2019, nearly half of those denied obtained surgery at a later date
• Of those who never obtained weight-loss surgery, 40 percent were deceased at 12-year follow-up

Boston – More than 300,000 Americans die each year from conditions associated with being overweight or obese, including diabetes, high blood pressure, arthritis, heart disease and sleep apnea. To date, metabolic and bariatric surgery (MBS)—with metabolic surgery defined as weight loss surgery as targeted treatment for diabetes—has proven to be the most effective means of losing weight and keeping it off over the long term. Yet many patients seeking the procedure are denied it, either by insurance providers, and/or because they fail to meet current medical criteria.

To learn what happened to patients denied weight loss surgery, physician-scientists at Beth Israel Deaconess Medical Center (BIDMC) followed up with 107 patients who were denied the procedure in 2007. The team found that most patients who were initially turned away eventually obtained bariatric surgery, experienced improved overall health and were still living at 12- year follow up. However, 40 percent of those denied surgery in 2007 who never underwent the procedure were deceased by 2019. The findings were published in the journal Surgery for Obesity and Related Diseases.

“Denying patients seeking bariatric surgery was a death sentence for nearly the 40 percent of patients who never obtained a metabolic operation after initial denial,” said senior author Daniel B. Jones, MD, Chief of Minimally Invasive Surgical Services and Director of the Bariatric Program at BIDMC. “Our findings suggest current insurance criteria for accepting or denying patients for weight loss surgery are unnecessarily stringent, potentially harmful to patients and should be reassessed.”

Using a database of patients maintained by an accredited academic bariatric program, Jones and colleagues identified 107 patients denied metabolic and bariatric surgery in 2007. A total of 64 patients consented to participate in the follow-up survey or were found to be deceased. The researchers collected data from these 64 patients’ charts and conducted telephone surveys with still-living patients.

The team found that of the 64 patients initially denied MBS, 29 of them ultimately underwent weight loss surgery. All 29 were still living at 12-year follow up and, while the data were not significant, were found to be at a lower mean body mass index and take fewer medications than their counterparts who never underwent the surgery.

Meanwhile, of the 35 patients who never underwent weight loss surgery, 14 were deceased at 12-year follow up. The remaining living 21 patients who were initially denied would now be eligible for weight loss surgery today based on current medical guidelines.

While the 64 patients initially denied bariatric surgery were turned away for a variety of reasons—including poor medical fitness for surgery, failure to meet body mass index criteria, and psychological concerns—29 were denied due to insurance barriers.

“Ultimately, this sheds light on the presumed costs of treating patients with morbid obesity over the long terms with surgery versus medical treatments,” said Jones. “Regardless of the bottom line, the benefits of patients’ overall health and wellbeing after successful weight loss cannot be understated.”

In addition to Jones, co-authors included Mojdeh S. Kappus MD, Blaine T. Phillips MD, Nicholas Zenquis, Evgeniya Larionova F-NP, Jaime Cudmore, of BIDMC.

The authors have no conflicts of interest to disclose.