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Many insurance payors mandate that candidates for bariatric surgery participate in a medically-supervised weight management program (MSWM) as a prerequisite for obtaining surgery. However, there is little evidence to support the underlying hypothesis that MSWM improves post-operative compliance and outcomes. Requiring MSWM participation may actually delay medically benefical treatment. To our knowledge, there is no randomized study specifically addressing the effect of a pre-operative insurance-mandated MSWM program on post-surgical weight loss or weight maintenance. Furthermore, prior studies have not addressed the potentially deleterious issue of drop-off, i.e. the degree to which a 6-month MSWM requirement results in otherwise eligible patients becoming ineligible for surgery. Our goal in this study is to conduct a rigorous, single-site pilot study that will address these important research questions. Our current structure of close collaboration between an outpatient medical weight loss clinic / referral center and a bariatric surgery program, along with the unique demographic of our patients and current wait time to surgery, provide an ideal setting to test whether an insurance-mandated MSWM program provides any benefit above and beyond usual care. In a one-year randomized controlled trial (see Figure), we propose to study this question in an underserved, urban population that already faces many barriers to care. Patients whose insurance does not require such a mandated program and who meet NIH consensus criteria will be randomized to a six-month MSWM program or usual care, and followed for outcomes postoperatively at 3 months, 6 months, and 1 year. Our primary outcome of interest is the percent of excess weight loss. Secondary outcomes include measures of patient behavior change (adherence, activation, and dietary behavior change) and patient satisfaction. We anticipate our study will provide results relevant to many stakeholders: for patients and their providers evidence that typical bariatric program practices provide equivalent or improved clinical results over MSWM programs; for administrators and policymakers data to counter the undue burdens imposed by insurance mandates; and for researchers additional evidence on patient behavior factors related to improved postoperative clinical outcomes.

Another ongoing areas of research:

1. Disparities in access to bariatric surgery in underserved/minority patients with severe obesity

2. The role of metabolic/bariatric surgery in patients with Type 2 Diabetes and Body Mass Index > 35

3. The prevalence of thrombophilia in patients undergoing sleeve gastrectomy 

4. Surgical strategies to reduce leak after laparoscopic sleeve gastrectomy

5. The mechanism of portal vein thrombosis after laparoscopic sleeve gastrectomy