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

Erin Takemoto, Bruce Wolfe, Corey Nagel, Walter Pories, David R. Flum, Alfons Pomp, James Mitchell, Janne Heinonen

Research output: Contribution to journalArticle

2 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)1-10
Number of pages10
JournalInternational Journal of Obesity
DOIs
StateAccepted/In press - Jun 11 2018

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Insurance Coverage
Bariatric Surgery
Medicaid
Weight Loss
Weights and Measures
Gastric Bypass
Gastrectomy
Insurance
Obesity

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Endocrinology, Diabetes and Metabolism
  • Nutrition and Dietetics

Cite this

Insurance status differences in weight loss and regain over 5 years following bariatric surgery. / Takemoto, Erin; Wolfe, Bruce; Nagel, Corey; Pories, Walter; Flum, David R.; Pomp, Alfons; Mitchell, James; Heinonen, Janne.

In: International Journal of Obesity, 11.06.2018, p. 1-10.

Research output: Contribution to journalArticle

Takemoto, Erin ; Wolfe, Bruce ; Nagel, Corey ; Pories, Walter ; Flum, David R. ; Pomp, Alfons ; Mitchell, James ; Heinonen, Janne. / Insurance status differences in weight loss and regain over 5 years following bariatric surgery. In: International Journal of Obesity. 2018 ; pp. 1-10.
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title = "Insurance status differences in weight loss and regain over 5 years following bariatric surgery",
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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T1 - Insurance status differences in weight loss and regain over 5 years following bariatric surgery

AU - Takemoto, Erin

AU - Wolfe, Bruce

AU - Nagel, Corey

AU - Pories, Walter

AU - Flum, David R.

AU - Pomp, Alfons

AU - Mitchell, James

AU - Heinonen, Janne

PY - 2018/6/11

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N2 - 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.

AB - 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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