‘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.

कोरोना हा सहव्याधी रुग्णांसाठी जसा जीवघेणा आहे, तसाच तो स्थूल लोकांसाठीसुद्धा धोकादायक आहे. लठ्ठपणा या आजाराचे शिकार असलेल्या लोकांना कोविडमुळे श्वसनात अनेक अडचणी येतात आणि त्यामुळे त्यांच्या जीवाला धोका निर्माण होतो. त्यामुळे आता स्थूलपणाला कात्री लावण्यासाठी लोकं बॅरिएट्रीक सर्जरीकडे वळत आहेत.

स्थूलव्यक्ती मरता-मरता बचावले

वाढत्या स्थूलतेकडे दुर्लक्ष करणार्‍या माणसांनी आता अंगावर वाढलेली अतिरिक्त चरबी घटवण्याकडे कटाक्षाने लक्ष देण्यास सुरुवात केलीय. कोव्हिडची बाधा झाल्यानंतर थोडक्यात बचावलेले रुग्ण आता कटाक्षाने वजन नियंत्रित राखण्यात तसेच बॅरिएट्रीक शस्त्रक्रिया करण्याकडे लक्ष देत आहेत. यापैकी बॅरिएट्रीक शस्त्रक्रिया करणा-या रुग्णांचे प्रमाण लक्षणीय असल्याचे मत लीलावती रुग्णालयाचे बॅरिएट्रीक सर्जन डॉक्टर शशांक शाह यांनी व्यक्त केले. या शस्त्रक्रियांना आता इन्शुअरन्सचाही आधार मिळू लागल्याने रुग्णांचा आर्थिक भारही हलका झाला आहे. त्यामुळे या शस्त्रक्रिया वाढू लागल्या आहेत. चुकीच्या जीवनशैलीमुळे आता सर्व वयोमानात स्थूलता दिसून येत आहे. मुळात स्थूलता हा आजार असल्याबाबत आजही जनसामान्यांमध्ये संमिश्र प्रतिक्रिया आहेत. ज्या रुग्णांनी औषधोपचार घेतले त्यांनाही कित्येकदा पुन्हा स्थूलतेचा सामना करावा लागला. परंतु कोव्हिडकाळात हे रुग्ण मरता -मरता बचावले, असेही डॉक्टर शाह म्हणाले.

डॉ. शहांनी सांगितला अनुभव

स्थूल रुग्णांना उपचारांना प्रतिसाद देताना असंख्य अडचणी निर्माण झाल्या. परिणामी, मृत्यू पावलेल्या रुग्णांमध्ये स्थूलतेचे प्रमाण जास्त असल्याचा निष्कर्ष डॉक्टरांनी मांडला. याबाबतचा अनुभव मांडताना बॅरीएट्रीक सर्जन डॉक्टर शशांक शाह यांनी सख्या दोन भावांचे उदाहरण देखील दिले.यापैकी ज्या भावाने वजन नियंत्रित न राहिल्याने बॅरिएट्रीक शस्रक्रियेकडे कानाडोळा केला,त्याला कोविड झाल्यानंतर कित्येक दिवस अतिदक्षता विभागात उपचार घ्यावे लागले. मरणातून वाचल्यानंतर त्याने दीड महिन्यानंतर त्वरित बॅरिएट्रीक शस्रक्रिया केली, अशी माहिती शाह यांनी दिली. मात्र ज्या भावाने कोविडची बाधा होण्याअगोदरच बॅरिएट्रीक शस्रक्रिया केलेली त्याच्या उपचारांत अडचणी आल्या नाहीत, तो या जीवघेण्या आजारातून सुखरुप बाहेर आला, असं शाह पुढे म्हणाले.

बॅरिएट्रिक शस्त्रक्रियेविषयी

• बॅरिएट्रिक शस्त्रक्रियांना चयापचय शस्त्रक्रिया म्हणून देखील ओळखले जाते, कारण ते मूळ कारणांवर कार्य करतात आणि चयापचय गतिमान करतात. हे बदललेल्या आतड्यांसंबंधी मार्गाद्वारे आणि आतड्यांच्या वेगवेगळ्या भागांना उत्तेजन देऊन होते. या उत्तेजनामुळे हार्मोन्सचा स्राव होतो ज्यामुळे भूक कमी होते, तृप्तता सुधारते आणि वजन कमी होते.
• या प्रक्रिया मधुमेह, रक्तदाब, सांधेदुखी, स्लीप एपनिया इत्यादी स्थूलपणाशी संबंधित सर्व आजारांना उलट करण्यासाठी ओळखल्या जातात आणि कॉमोरबिडीटी कमी करून आयुष्य वाढवण्यासाठी ओळखल्या जातात.

स्थूलतेच्या शस्त्रक्रियेसाठी कसा मिळतो इन्शुअरन्स

• हृदय विकार, मधुमेह आणि झोपेची समस्या असलेल्या रुग्णांना स्थूलतेचा आजार असल्यास इन्शुअरन्स कंपन्यांकडून बॅरिएट्रीक शस्त्रक्रियेसाठी आर्थिक उपाययोजना केल्या जातात.
• खासगी रुग्णालयात बॅरिएट्रीक शस्त्रक्रियांचा खर्च हा २ ते ५ लाखांपर्यंत जातो. तर सरकारी रुग्णालयांत या शस्त्रक्रियेसाठी मोठी किंमत मोजावी लागत नाही.

Obesity and diets are thought to be interlinked. Different types of diets exist, each one claiming benefits over the other, often confusing the reader about which is the best diet for him or for her. We attempt to offer a comprehensive summary about how you can choose the best diet for yourself. Diets have a better role in prevention of obesity as well as maintenance of weight loss, however dietary therapy alone for weight loss has not offered the best results for long term “weight loss maintenance”.
Rachel Freire has published a great summary in his review article published in ‘Nutrition’ Journal which included a study of different types of diets like intermittent fasting, keto diet, calorie restricted diet, Very low calorie diet, low carbohydrate diet (most commonly adopted diets) , and concluded as follows:

1. The creation of new diets will continue to follow popular trends. However, the belief that these diets promote weight loss has emerged more from personal impressions and reports published in books, rather than from rigorously controlled research.
2. Over several decades, efforts have been concentrated on clinical trials to determine the best diet for the treatment of obesity. Unfortunately, the evidence remains inconclusive and contested, and the trials present important limitations.
3. In the “short term” diet promote different degrees of success, but in the “long term”, the small difference does not instill confidence for prescribing one diet over another.https://pubmed.ncbi.nlm.nih.gov/31525701/

Despite the above conclusion, people do experience different types of response or success in losing weight.However, the response remains unpredictable and grossly variable among people .This clearly suggests that there are some factors in the human body which modulate or govern the response to a therapy .These could be the genetic tendency, epigenetic expression ,intestinal bacteria/gut microbiota ,environmental and socio economic factors ,sleep cycle , stress, associated medical conditions , nutritional status ,etc., which have an impact on the body’s tendency to store a certain percentage of fat also known as ‘the set point of obesity’ in that individual. Eventually, the hormonal response generated in the body by all the factors mentioned above may induce an imbalance in the metabolism resulting in the disease of obesity in an individual. Hence the treatment of the disease of obesity should be based on evidence based scientific protocol just like the treatment of any other chronic disease e.g., Hypertension, cancers, etc.

Unfortunately, patients with obesity are blamed for unhealthy eating habits and /or lifestyle. This is more commonly seen as a bias especially when viewed by a normal weight or a lean individual or clinician or any therapist. This is simply because of a tendency to compare one’s own habits and response and an attempt to apply the same to others. I would like to state here that many scientific organizations in the world like AMA,American Medical Association, OSSI,Obesity Surgery Society of India declared “Obesity as a disease’’and‘not just a lifestyle disorder’.Even bariatric surgery started being called metabolic surgery after better understanding of the altered metabolism in people with obesity. Bariatric surgery got included in the insurance cover, which clearly explains that obesity is accepted as a disease.

I would like to discuss some important and common myths about Obesity.

Myth 1 : OBESITY IS CAUSED ONLY BECAUSE OF WRONG DIETS
We often see people who eat freely and still maintain their weight and also those who try to eat less but still remain in the category of overweight or obesity. Some are thought to be blessed with a metabolism to remain thin or normal weight ever.At the same time those who are not blessed with such metabolism are blamed. Prof. Lee Kaplan et al published the explanation for this after a multigenerational multicentered study known as “MARS”. I strongly recommend all those who feel that” those who cannot lose weight do not have willpower “to read the Myth published in “MARS”. https://jnjinstitute.com/en-

The study clearly states a myth which even doctors and clinicians find difficult to believe. The MARS study clearly concluded that “weight cannot be reliably controlled by voluntarily adjusting energy balance through diet and exercise “. The converse is also true for very lean and thin who try to gain weight by increasing calories and still don’t succeed .

Myth 2 : ANY GRADE OF OBESITY CAN BE TREATED WITH DIET INTERVENTION AND EXERCISE.

As mentioned earlier, obesity is a disease and needs to be treated like all other diseases. Treatment of any disease is based on grade, severity, and stage of the disease. Forexample, the treatment for cancer varies depending on the type and grade of disease and it is well known that the best results are seen only in those who are diagnosed early and treated in time as per the best available evidence-based therapy of that cancer. Needless to say that the same thing holds true for the treatment of obesity at various stages.

Evidence based/BMI (Body Mass Index) based algorithm for obesity.
Note : Even though BMI has its limitations , the algorithm can be generally applicable to all , with some exceptions.

The algorithm shows that diet and exercise are present in all the approaches for the treatment of obesity but this algorithm also indicates that diet and lifestyle change cannot be a single line of treatment when you cross a certain grade of obesity and it should always be accompanied by other complimentary therapies.

In conclusion, diet for weight loss can be adopted a jumpstart. Caution is required for each diet and hence it should be the diet supervised by a qualified nutritionist. Maintenance of weight loss may require supervision from qualified obesity experts. Failure of therapy should not be considered as failure on part of the patient. Start a dietary change which has “no expiry date”.

Diets most often fail to work in patients with morbid obesity. Metabolic and bariatric surgery is the only proven long-term treatment for morbid obesity till further research would invent medications which can mimic the metabolic and hormonal change after bariatric surgery.