Missing Link: Obesity Surgery Follow-up

Obesity surgery follow-up — no surprise — is essential for good outcomes. That’s the conclusion of a new review and meta-analysis of gastric bypass outcomes just published in Obesity Surgery. Patients who were compliant with follow-up appointments achieved more than 6% additional excess weight loss than those who were not.

The notion that good follow-up is necessary for the best outcomes has long been well accepted for gastric banding surgery. After all, the band is adjustable and much has been made of the importance of follow-up visits to keep patients within a sweet spot of appetite control. But gastric bypass is often considered a one-and-done procedure. Many studies, viewed in isolation, found that differences between gastric bypass patients with and without good follow-up were insignificant. Such findings lined up with the understanding of bypass as a “non-adjustable” procedure.

Though the American Society for Metabolic and Bariatric Surgery recommends follow-up at three months, six months, and annually thereafter for three years, many factors get in the way. Health insurance plans have a bad reputation for dickering with patients over covering follow-up care. Patients who have traveled to a Bariatric Center of Excellence are not keen to spend more time spent travelling back to a distant center. And problems with weight regain are a source of great embarrassment and fear that leads some patients to avoid their surgical team.

These findings should be a wake-up call. Regardless of the procedure, follow-up care is important. People who commit to obesity surgery have too much at stake to just walk away after the procedure is over. We need a better evidence base to support optimal follow-up strategies. And health plans need to do their part to make follow-up care a no-brainer, rather than one more occasion to nickle and dime patients who are already deeply invested.

It’s absurd to put the investment in obesity surgery at risk with a haphazard system of follow-up.

Click here to read more from the Obesity Action Coalition and here to read the study in Obesity Surgery.

Reminders, photograph © Jinx! / flickr

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