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

Background: Studies of obesity surgery are frequently criticized for lack o f an appropriate nonoperative control arm. Additionally, insurance approval for coverage of these procedures can be difficult to obtain by patients an d caregivers. This retrospective study tested the hypothesis that the insur ance preapproval process would yield well-matched operative and non-operati ve treatment groups which could simulate a randomization process. Methods: Of 466 patients deemed to be appropriate candidates for surgery, 5 8% ultimately received surgical therapy. Roux-en-Y gastric bypass (RYGBP) w as performed on 244 patients who were compared with 187 patients who did no t undergo surgery (NonOP). Results: The groups were similar in gender (81% female), age (39 yr), and B ody Mass Index (52 kg/m(2)). The percentage of African Americans in the Non OP group was greater. The distribution of comorbid conditions among the gro ups were similar. Conclusions: The insurance approval process results in a reasonable control group for parameters except race.