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Bariatric Surgery

Insurance status differences in weight loss and regain over 5 years following bariatric surgery

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Abstract

Background

The effectiveness of bariatric surgery among Medicaid beneficiaries, a population with a disproportionately high burden of obesity, remains unclear. We sought to determine if weight loss and regain following bariatric surgery differed in Medicaid patients compared to commercial insurance.

Subjects/methods

Data from the Longitudinal Assessment of Bariatric Surgery, a ten-site observational cohort of adults undergoing bariatric surgery (2006–2009) were examined for patients who underwent Roux-en-Y Gastric Bypass (RYGB), Laparoscopic Adjustable Band (LAGB), or Sleeve Gastrectomy (SG). Using piecewise spline linear mixed-effect models, weight change over 5 years was modeled as a function of insurance type (Medicaid, N = 190; commercially insured, N = 1448), time, procedure type, and sociodemographic characteristics; additionally, interactions between all time, insurance, and procedure type indicators allowed time- and procedure-specific associations with insurance type. For each time-spline, mean (kg) difference in weight change in commercially insured versus Medicaid patients was calculated.

Results

Medicaid patients had higher mean weight at baseline (138.3 kg vs. 131.2 kg). From 0 to 1 year post-operatively, Medicaid patients lost similar amounts of weight to commercial patients following all procedure types (mean weight Δ difference [95% CI]: RYGB: −0.9 [−3.2, 1.4]; LAGB: −1.5 [−6.7, 3.8]; SG: 5.1 [−4.0, 14.2]). From 1 to 3 years post-operatively Medicaid and commercial patients continued to experience minimal weight loss or began to slowly regain weight (mean weight Δ difference [95% CI]: RYGB: 0.9 [0.0, 2.0]; LAGB: −2.1 [−4.2, 0.1]; SG: 0.7 [−3.0, 4.3]). From 3 to 5 years post-operatively, the rate of regain tended to be faster among commercial patients compared to Medicaid patients (mean weight Δ difference [95% CI]: RYGB: 1.1 [0.1, 2.0]; LAGB: 1.5 [−0.5, 3.5]; SG: 1.0 [−2.5, 4.5]).

Conclusions

Although Medicaid patients had a higher baseline weight, they achieved similar amounts of weight loss and tended to regain weight at a slower rate than commercial patients.

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References

  1. CDC. Adult Obesity Causes & Consequences 2016. https://www.cdc.gov/obesity/adult/causes.html.

  2. Stunkard AJ, Stinnett JL, Smoller JW. Psychological and social aspects of the surgical treatment of obesity. Am J Psychiatry. 1986;143:417–29.

    Article  PubMed  CAS  Google Scholar 

  3. Velcu LM, Adolphine R, Mourelo R, Cottam DR, Angus LD. Weight loss, quality of life and employment status after Roux-en-Y gastric bypass: 5-year analysis. Surg Obes Relat Dis. 2005;1:413–6. discussion 7

    Article  PubMed  Google Scholar 

  4. Courcoulas AP, Christian NJ, Belle SH, Berk PD, Flum DR, Garcia L, et al. Weight change and health outcomes at 3 years after bariatric surgery among individuals with severe obesity. JAMA. 2013;310:2416–25.

    PubMed  PubMed Central  CAS  Google Scholar 

  5. Courcoulas AP, Yanovski SZ, Bonds D, Eggerman TL, Horlick M, Staten MA, et al. Long-term outcomes of bariatric surgery: a National Institutes of Health symposium. JAMA Surg. 2014;149:1323–9.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Jensen MD, Ryan DH, Apovian CM, Ard JD, Comuzzie AG, Donato KA, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. J Am Coll Cardiol. 2014;63(25 Pt B):2985–3023.

    Article  PubMed  Google Scholar 

  7. Alexander JW, Goodman HR, Hawver LRM, James L. The impact of medicaid status on outcome after gastric bypass. Obes Surg. 2008;18:1241–5.

    Article  PubMed  Google Scholar 

  8. Gomez JP, Davis MA, Slotman GJ. In the superobese, weight loss and resolution of obesity comorbidities after biliopancreatic bypass and/or duodenal switch vary according to health insurance carrier: Medicaid vs Medicare vs Private insurance vs Self-Pay in 1681 Bariatric Outcomes Longitudinal Database patients. Am J Surg. 2016;211:519–24.

    Article  PubMed  Google Scholar 

  9. Hayes S, Napolitano MA, Lent MR, Wood GC, Gerhard GS, Irving BA, et al. The effect of insurance status on pre- and post-operative bariatric surgery outcomes. Obes Surg. 2015;25:191–4.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Jensen-Otsu E, Ward EK, Mitchell B, Schoen JA, Rothchild K, Mitchell NS, et al. The effect of Medicaid status on weight loss, hospital length of stay, and 30-day readmission after laparoscopic Roux-en-Y gastric bypass surgery. Obes Surg. 2015;25:295–301.

    Article  PubMed  Google Scholar 

  11. Chen EY, Fox BT, Suzo A, Greenberg JA, Campos GM, Garren MJ, et al. One-year surgical outcomes and costs for medicaid versus non-medicaid patients undergoing laparoscopic Roux-en-Y Gastric Bypass: a single-center study. Surg Laparosc Endosc Percutan Tech. 2016;26:38–43.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Funk LM, Suzo A, Mikami DJ, Needleman BJ. Two-year outcomes for medicaid patients undergoing laparoscopic Roux-en-Y gastric bypass: a case-control study. Obes Surg. 2014;24:1679–85.

    Article  PubMed  Google Scholar 

  13. Melton GB, Steele KE, Schweitzer MA, Lidor AO, Magnuson TH. Suboptimal weight loss after gastric bypass surgery: correlation of demographics, comorbidities, and insurance status with outcomes. J Gastrointest Surg. 2008;12:250–5.

    Article  PubMed  Google Scholar 

  14. Purnell JQ, Selzer F, Wahed AS, Pender J, Pories W, Pomp A, et al. Type 2 diabetes remission rates after laparoscopic gastric bypass and gastric banding: results of the Longitudinal Assessment of Bariatric Surgery study. Diabetes Care. 2016;39:1101–7.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  15. Belle SH, Berk PD, Chapman WH, Christian NJ, Courcoulas AP, Dakin GF, et al. Baseline characteristics of participants in the Longitudinal Assessment of Bariatric Surgery-2 (LABS-2) study. Surg Obes Relat Dis. 2013;9:926–35.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Belle S, Consortium L. The NIDDK Bariatric Surgery Clinical Research Consortium (LABS). Surg Obes Relat Dis. 2005;1:145–7.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Belle SH, Berk PD, Courcoulas AP, Flum DR, Miles CW, Mitchell JE, et al. Safety and efficacy of bariatric surgery: Longitudinal Assessment of Bariatric Surgery. Surg Obes Relat Dis. 2007;3:116–26.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Christian NJ, King WC, Yanovski SZ, Courcoulas AP, Belle SH. Validity of self-reported weights following bariatric surgery. JAMA. 2013;310:2454–6.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  19. Fitzmaurice GM, Laird NM, Ware JH. Applied longitudinal analysis. 2nd ed. Hoboken, NJ: Wiley; 2011. xxv, 701pp.

  20. Ibrahim JG, Molenberghs G. Missing data methods in longitudinal studies: a review. Test (Madr). 2009;18:1–43.

    Article  Google Scholar 

  21. Dallal RM, Quebbemann BB, Hunt LH, Braitman LE. Analysis of weight loss after bariatric surgery using mixed-effects linear modeling. Obes Surg. 2009;19:732–7.

    Article  PubMed  Google Scholar 

  22. Livingston EH, Ko CY. Socioeconomic characteristics of the population eligible for obesity surgery. Surgery. 2004;135:288–96.

    Article  PubMed  Google Scholar 

  23. Martin M, Beekley A, Kjorstad R, Sebesta J. Socioeconomic disparities in eligibility and access to bariatric surgery: a national population-based analysis. Surg Obes Relat Dis. 2010;6:8–15.

    Article  PubMed  Google Scholar 

  24. Ponce J, DeMaria EJ, Nguyen NT, Hutter M, Sudan R, Morton JM. American Society for Metabolic and Bariatric Surgery estimation of bariatric surgery procedures in 2015 and surgeon workforce in the United States. Surg Obes Relat Dis. 2016;12:1637–9.

    Article  PubMed  Google Scholar 

  25. Puzziferri N, Roshek TB 3rd, Mayo HG, Gallagher R, Belle SH, Livingston EH. Long-term follow-up after bariatric surgery: a systematic review. JAMA. 2014;312:934–42.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

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Acknowledgements

LABS-2 was funded by a cooperative agreement by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Grant numbers: Data Coordinating Center, U01 DK066557; Columbia-Presbyterian, U01- DK66667 (in collaboration with Cornell University Medical Center CTSC, grant UL1-RR024996); University of Washington, U01-DK66568 (in collaboration with CTRC, grant M01 RR-00037); Neuropsychiatric Research Institute, U01- DK66471; East Carolina University, U01-DK66526; University of Pittsburgh Medical Center, U01-DK66585 (in collaboration with CTRC, grant UL1-RR024153); and Oregon Health & Science University, U01-DK66555. Abstract of these results were presented at the Society for Epidemiologic Research annual meeting on June 22nd, 2017 (Seattle, WA).

Funding

Dr. Flum has had an advisor role with Pacira Pharmaceuticals, has provided expert testimony for Surgical Consulting LLC, and has received travel expenses from Patient Centered outcomes research institute. Dr. Wolfe has received a research grant from Enteromedics. Dr. Pomp is a consultant and speaker for Medtronic and Ethicon and WL Gore and Associates.

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Authors and Affiliations

  1. Oregon Health & Science University—Portland State University School of Public Health, 3181 SW Sam Jackson Park Rd., Mail Code CB669, Portland, OR, 97239-3098, USA

    Erin Takemoto, Corey L. Nagel & Janne Boone-Heinonen

  2. Oregon Health & Science University School of Medicine Department of Surgery, Portland, OR, USA

    Bruce M. Wolfe

  3. East Carolina University School of Medicine Department of Surgery, Greenville, NC, USA

    Walter Pories

  4. University of Washington Department of Surgery, Seattle, WA, USA

    David R. Flum

  5. Weill Cornell Medical College Department of Surgery, New York, NY, USA

    Alfons Pomp

  6. Neuropsychiatric Research Institute, Fargo, ND, USA

    James Mitchell

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  1. Erin Takemoto
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  2. Bruce M. Wolfe
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  4. Walter Pories
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  5. David R. Flum
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  6. Alfons Pomp
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  7. James Mitchell
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  8. Janne Boone-Heinonen
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Correspondence to Erin Takemoto.

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Takemoto, E., Wolfe, B.M., Nagel, C.L. et al. Insurance status differences in weight loss and regain over 5 years following bariatric surgery. Int J Obes 42, 1211–1220 (2018). https://doi.org/10.1038/s41366-018-0131-0

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