Is It Time To Update The NIH Standards of 1991?

From cccblog.org

The times, they are a'changing.

Or so, some will hope.

A recent Lancet Diabetes and Endocrinology editorial posed the idea that the time has come to revisit the NIH guidelines of 1991 that spawned bariatric surgery indications and defined reimbursement schedules world wide.

Inherent in those recommendations was the idea that bariatric surgeries were confined to a 'last resort' status for weight loss and comorbidity treatment. Sounds outdated and reserved in contrast to how many view these procedures as life saving and metabolically capable of doing things that no other treatment can do - alone or in combination with other modalities.

So, with ever-increasing awareness and study-proven metabolic effects and other comorbidty resolution / improvement, and consistent proof of durable weight loss from these procedures, there is a new call for revisiting the guidelines in order to capture the true demographic of those who would benefit most from surgery, and notably a weight that may fall outside current reimbursable BMI standards.

"The question now is whether the operation would benefit other people who fail to qualify based on their degree of obesity," Dr. David E. Cummings said.  Type 2 DM is a progressive, chronic, and relentless disease, "but if you have a gastric bypass, you have an 80% chance of going into full remission, <and> it's clear now that <these procedures> are effective at getting rid of diabetes in thinner people who stand to lose less weight".

"It (also) appears that patients with high fasting insulin levels (prediabetic) stand to benefit the most from bariatric surgery in terms of cardiovascular morbidity and mortality...<and> the shorter duration of diabetes the better the outcome."

Also mentioned in the article is the safety of laparoscopic bariatric surgery, with "the same safety profile as a hip replacement, and 1/10th the mortality of coronary artery bypass," said Alfons Pomp, a bariatric surgeon from the department of surgery at Weill Cornell Medical College in New York City.

It will be interesting to see if these efforts gain any traction to open the indications for surgery in those that may benefit the most from an insurer's perspective as well.  It may take a while for that to be agreed upon, and even longer before it finds its way into a reimbursable benefit for that newer class of patient.

But, it's a start...