Obesity is a complex disease involving genetics, metabolism, hormones and life style. Morbid obesity which is also termed as severe obesity is a disease and it is approved as a disease by all medical councils, insurance companies, Govt, etc.

Just like any other diseases, IRDAI, Insurance Regulatory and Development Authority of India have approved morbid obesity as a disease. Hence treatment for morbid obesity including metabolic and bariatric surgery is covered under insurance.

What is morbid obesity :

Asian and Indian guidelines state that anyone with a BMI of 32.5 with obesity associated conditions or anyone with a BMI of 37.5 or above is termed to have morbid obesity.
However, Indian insurance companies have limited the insurance cover for the following:

• Anyone with a BMI above 40kg/m2 with obesity induced symptoms
• Anyone with a BMI above 35 with either uncontrolled type 2 diabetes or severe sleep apnoea or coronary heart disease.

Note : There is no definition for ‘severe’ sleep apnoea and hence a document or report or a specialist certificate is necessary.

Uncontrolled diabetes is when the HbA1c, or three months average sugar is above 7, or multiple blood sugar levels are very high; in spite of medical treatment for diabetes.
It is important to preserve all earlier medical record including prescriptions, doctors consultation notes, reports, etc.

Ideally a unit with two bariatric surgeons is preferred so that two bariatric surgeons can certify for the patient.
Patients are expected to preserve all records of earlier weight loss attempts.

Even though severe osteoarthritis, PCOS, migraine, urine incontinence, high lipid levels, knee or spine diseases, etc are also few of the main indications for bariatric surgery, insurance companies in India do not accept these for bariatric surgery cover. It is still recommended to have the documents related to the above as supporting documents.

When can one get insurance cover for bariatric surgery after having the insurance?

Some insurance companies have a waiting period of two to four years after the date of inception, that means from the date on which insurance was first stared.

Corporate insurance does not have any waiting period.

If you are suffering from morbid obesity and associated problems, metabolic and bariatric surgery is the best long term solution for you. If you have a valid insurance cover, you deserve to get insurance cover for the same.

What is intragastric balloon :

Intragastric balloon placement has been started in India at Laparo Obeso Centre since 2006 and LOC is known to be one of the pioneer balloon clinics in India. Since then,LOC has trained and certified many endoscopists and nutritionists.
Intragastric balloon is a non-invasive modality for weight loss. However, since the balloon needs to be removed after a period of time, it is accepted as a temporary method of weight loss.It is popular as a nonsurgical weight loss method for those who do not wish to undergo bariatric surgery or do not need surgery.
A silicon or similar balloon is filled with saline and occupies the space in the stomach.
The material of the balloon prevents it from being digested and hence stays in the stomach.Balloon can be swallowed or endoscopically placed in the stomach under sedation.

Who should undergo intragastric balloon for weight loss?

• Those who can’t lose weight after diet and exercise
• Ideal for those with an excess weight up to 10 to 15 kg
• PCOS
• Those with infertility needing weight loss
• Failed IVF and with obesity
• Cosmetic reasons

Balloon therapy is not ideal for patients with morbid obesity who require bariatric surgery.

How does gastric balloon work?

The balloon occupies the space in the stomach limiting the food intake. However, a person needs to be careful with the caloric intake to get the maximum benefit of weight loss. The balloon in the stomach gives a feeling of fullness and reduces hunger and cravings. However, the effect of balloon starts wearing off slowly and the person needs advice from a qualified bariatric nutritionist to learn to keep the food intake and calories to the lowest.

Is balloon a day care procedure?

Intragastric balloon placement is known to be a day care procedure and one can be discharged in about 3 to 4 hours.
Balloon is placed under short sedation and filled with saline under vision through an endoscope or gastroscope. could be some discomfort or pain for the first few days since the stomach would contract and attempt to digest the balloon.Some patients may need intravenous medications to suppress nausea and discomfort or pain after the balloon insertion. The discomfort usually disappears after about two to four days.

How much weight can be lost after the balloon?

It is generally said that a person can lose about 5 to 10 percent of weight. The results are variable based on the excess weight, BMI, metabolism and dietary compliance.
The weight loss is maximum in the initial 6 weeks and may slow down over time. Maintenance of weight loss is necessary with a proper follow up.

What is a swallowable balloon or a balloon pill?

These balloons are available as large capsules and can be swallowed by a person, with some difficulty. It is then confirmed under X ray vision that the balloon is inside the stomach. The balloon is attached to a tube through which saline can be instilled inside the balloon and the tube can be pulled. Some balloons rupture and pass out in about two to three months. The weight loss effect lasts for a very short time and needs to be maintained. This method is expensive and weight regain could be very rapid after the balloon passes out.

Can a gastric balloon be kept inside the stomach for a year?

There are balloons which can be left inside the stomach for one year, so that the weight loss benefits can be sustained for longer period. ‘Spatz’ balloons are adjustable balloons which can be left inside for a year. The word adjustable means that the same balloon can be further inflated with more saline so the effect of fullness and satiety can be augmented if the weight loss slows down or stops during the period of one year.
There are different types of balloons which can be kept up to 3,6 or 12 months. The effect of the balloon lasts longer if the balloon can be kept inside for a longer period.

Balloon removal procedure:

It is an outpatient procedure. Patient reaches the clinic fasting and under short sedation the saline/ fluid inside the balloon is sucked out with a special needle passed through the endoscope. Patient d

Can balloon rupture or leak?

The incidence of balloon leak is very low. However, the balloon is filled with saline tinged with a water-soluble dye known as methylene blue. If a balloon leaks, the methylene blue leaks in the stomach, absorbed and excreted through the urine. Urine turns bluish green and the person can immediately know it. In case of a leaked balloon, it can be safely removed or replaced with a new one. Balloons are made with silicon and hence can not rupture.

What are the contraindications for a balloon?

People with acidity or reflux disease are not recommended to have gastric balloon placed.
Ideally, an endoscopy is recommended to ensure whether it can suit a person.
Those on aspirin, blood thinners, pain killers are generally requested to avoid balloon placement.

What are the side effects of gastric balloon?

Side effects of balloon are usually mild and well tolerated.
Nausea, vomiting, abdominal discomfort or pain are the most common side effects seen initially and can be controlled easily with medications. Acidity is sometimes a challenge especially after spicy food and should be treated with antacids. Vitamin and protein supplements are needed to keep the nutritional status healthy.

‘75% patients received insurance claims in last six months at LOC’
Almost over 200 patients with morbid obesity underwent bariatric surgery at LOC Pune and Mumbai .
Those having a BMI more than 40 or had serious comorbidities like sleep apnoea or heart disease or uncontrolled diabetes could avail insurance cover for their bariatric surgery and the insurance coverage was almost upto 90 percent .

However , there were still a few who were denied claims in spite of qualifying the insurance norms for reasons not known !

Uninsured? Not really! Patients denied claims for weight loss surgery.

Insurance company covers or reimburses all illnesses which are not lifestyle induced. Obesity was earlier thought to be a lifestyle disorder but fortunately in today’s era since October 2020 morbid obesity is accepted as a disease and its treatment is covered under insurance and this will improve better understanding of obesity is a disease and help everyone take further steps for prevention of obesity.

IRDAI has now declared morbid obesity as a disease and included bariatric surgery as an insurance cover since October 2019 which was however, implemented from October 2020. The present criteria for inclusion relates to patients with or in excess of Body Mass Index (BMI) 40kg/m2, those with a BMI of 35kg/m2 with either obesity related cardiomyopathy or coronary heart disease, only coronary heart disease or severe sleep apnea, or uncontrolled diabetes. These four co-morbidities are the only ones in the inclusion criteria of the IRDAI regulations. It is still unknown why only these co-morbidities were chosen. There are co-morbidities like renal failure which are more life threatening but it is unknown why they are not included in the IRDAI guidelines. Obesity does give rise to other co-morbidities like severe joint pain, osteoarthritis, recurrent hernias, polycystic ovarian disease etc. These are not yet included in the bariatric surgery insurance cover even though they are obesity-related co morbidities. It is incongruous to accept that obesity induces osteoarthritis and joint pain yet bariatric surgery is not covered by insurance but joint replacement surgery which could have been prevented is covered by insurance. Any health challenges that can be life-threatening or that make a patient suffer from a disease should be covered by insurance companies.

However, it may probably still take insurance companies some more time to cover all co-morbidities of obesity included under insurance cover. This is Mehta from Ghatkopar Mumbai had a BMI of 47 with severe sleep apnoea breathlessness and had difficulty walking. She underwent bariatric surgery successfully by Dr Shashank Shah however it was Surprising to find that in spite of having a BMI of 47 and all comorbidities her claim was rejected by the insurance company. Mrs Shah from Baramati had the same experience there are many such patients who are still struggling to get their claims in spite of being deserving as per the present guidelines.

Mr. Santhanam from Mumbai, with a BMI of 43kg/m2 underwent bariatric surgery in Mumbai, got the complete insurance reimbursement of 4 lakhs. “I thought Bariatric surgery was under cosmetic treatment and would not get insurance reimbursement but after Dr Shah told me about how it is a disease and how I can get a reimbursement I applied and was pleasantly surprised to have my claim passed.”

Some Facts For The Readers :

Those with corporate insurance do not have any waiting period or exclusion for pre-existing diseases and hence they are more eligible for getting insurance cover for bariatric surgery if they are morbidly obese. Those with individual policies need to have a waiting period with a maximum declared by IRDAI of 48 months to 4 years, so anyone with an insurance cover of more than 4 years is eligible for bariatric surgery in Pune and Mumbai covered if they fall into the criteria declared by IRDAI.

The IRDAI criteria are mandatory for each and every insurance company in the country to follow however documentation of co-morbidities needs to be scientific and backed up by a report from a medical specialist with evidence only then it will be granted. It is important for every individual to know that declaration of their co-morbidities at the time of insurance policy has to be true and authentic and there should not be any exclusion to avoid non-approval of claims in future.

“I believe that this is an excellent initiative by IRDAI and government and it is going to save a lot of costs for the insurance company as well as the society as well as for our country because obesity is known to give rise to multiple comorbidities like heart disease, kidney disease, joint replacement, and recurrent hernia repair surgery in cities like Pune and all these costs, in the long run, can be saved. In fact, even the productivity of an individual would increase if they lose weight in time and increased longevity leads to more productivity,” said Dr. Shashank Shah, pioneer Bariatric Surgeon and the past president of various obesity surgery associations, was one of the first practitioners to push the need of insurance for patients suffering from obesity.
Bariatric surgery is known to improve the overall quality of life, self-esteem, confidence, and the overall performance of a person both in the personal space and in the family or social fabric. The incidences of obesity in India are on the rise and it is more seen in the pediatric age group thereby creating a critical need for our administrative machinery to take every step in preventing obesity and its associated type-2 diabetes in our population; however, those who have unfortunately crossed the stage should get this opportunity to get treated using their insurance cover.

Obesity has been long touted as an expensive disease for treatment since patients incur higher expenses on food, clothing, travel, medication, and treatment of many associated co-morbidities over many years as compared to most other ailments. Therefore, insurance cover has come as a boon for patients seeking bariatric surgery for obesity and its related co-morbidities.

Significance Of LOC Towards Insurance Acceptance

“In last 6 months almost 75% patients undergoing bariatric surgery at Laparo Obeso Centre, LOC Healthcare, Pune have received insurance coverage or reimbursement,” said Dr. Shah, he welcomed this gesture of IRDAI and insurance companies.

LOC Healthcare LLP, known as Laparo Obeso Centre is an Internationally Accredited Centre of Excellence and certified by the Obesity Surgery Society of India as well as International Excellence Federation.

LOC has been one of the pioneer centers in Asia for metabolic and Bariatric surgeries as well as training for Bariatric surgeons.

LOC has successfully treated over 8000 patients with morbid obesity and has three world records in bariatric surgery to the credit.

LOC has made a significant contribution towards Bariatric surgery insurance acceptance.