Supervised Diets

Most patients ask, “Why do I need a supervised diet to be eligible for bariatric surgery? I have lost 100 pounds ten times. I have been on a diet my entire life!” Supervised diets are frequently required by insurance companies prior to authorization for weight loss surgeries such as gastric sleeve or gastric bypass. There is little data published that show supervised diets improving any outcomes. However, it is still very common for patients to have to go through a 3-month or 6-month program and demonstrate an attempt at overall weight loss from start to finish. My personal opinion is that these scheduled diets proposed by the insurance companies can make you a good post-operative bariatric patient. They are suggested so that patients learn to read labels, prepare proper foods, search for high protein and low carbohydrate food, and refrain from fast foods. Here are some tips to ensure a smooth approval process for your weight loss procedure!

How many visits ??
- The vast majority of plans require either 3 months or 6 months. Some require none at all (Medicare patients) Rarely, plans will require more than 6 months (some Medicaid Plans). Work with your insurance clearance team or call your carrier to find out exactly how many visits are required by your specific plan.

How much weight must one lose ??
- Most plans just require that you complete the specific number of supervised diet visits. Afterall, the overall goal is learning the specifics and principles of non-surgical weight loss. Occasionally, a patient may develop significant weight loss and decide to continue without surgical intervention. If this choice becomes apparent, this is always encouraged. Most plans do not specify a weight to be lost, just participation and progression (little to no weight gain). In some cases, if there is moderate weight gain, the procedure will not be approved.

With whom do you have your supervised diet with?
- Often it is not mandated who your diet plan is with. We plan on supervising your diet personally with either our physician, nurse practitioner, and/or dietician.
- However, our office is not the only option. Some insurance plans allow your family physician or a personal dietician to regulate the plan. If you plan on one of these options, we have forms that may help your practitioner fulfill your needs.
- On occasion,it’s required to do your weight loss trial with someone other than your surgeon. Make sure you are accomplishing what is needed based on your specific insurance. We are here to help you understand and follow the recommendations
All insurance policies have a requirement on what qualifies for weight loss surgery.
- If the insurance policy indicates that weight loss surgery is not covered, it is unlikely to be overturned. Standard recommendations for covered patients include:
- A BMI of 35-40 with co-morbid conditions which are weight related, including diabetes mellitus, hypertension, hypercholesterolemia, sleep apnea, limited mobility and others
- A BMI of 40 or higher alone or with co-morbid conditions

What else might your insurance policy demand ?
- Most insurance policies want to make sure there is not an endocrine related condition causing weight gain, you are not dependent on medications or drugs, and you are a safe candidate for operation.
- Most insurance companies require:
  - A drug screen
  - A cardiology clearance
  - Laboratory data
  - A psychology evaluation
  - Occasionally, a pulmonary consultation
- We use your scheduled visits for monthly weight checks to space out and complete the requirements of your insurance policy
After you have completed all of the requirements, it is recommended that you continue seeing your physician until the surgery is scheduled. Whatever the length of diet, If the diet is not completed in consecutive months you may be requested to start over.