Insurance decisions about obesity surgery: a new type of randomization?

Studies of obesity surgery are frequently criticized for lack of an appropriate non-operative control arm. Additionally, insurance approval for coverage of these procedures can be difficult to obtain by patients and caregivers. This retrospective study tested the hypothesis that the insurance preapproval process would yield well-matched operative and non-operative treatment groups which could simulate a randomization process.

Of 466 patients deemed to be appropriate candidates for surgery, 58% ultimately received surgical therapy. Roux-en-Y gastric bypass (RYGBP) was performed on 244 patients who were compared with 187 patients who did not undergo surgery (NonOP).

The groups were similar in gender (81% female), age (39 yr), and Body Mass Index (52 kg/m2). The percentage of African Americans in the NonOP group was greater. The distribution of comorbid conditions among the groups were similar.

The insurance approval process results in a reasonable control group for parameters except race.