Many patients who seek weight loss surgery are denied an operation due to insurance barriers, psychological concerns, failure to meet body mass index criteria, and poor medical fitness for surgery. The aim of this cohort study was to determine the natural history of patients denied eligibility for metabolic and bariatric surgery (MBS). From January-December 2007, a multidisciplinary, accredited MBS program denied 105 patients surgery. Twelve years later a retrospective chart review and phone survey was conducted. Qualitative and quantitative analysis was performed using chi-square and t-test, respectively. Forty patients either declined participation or were lost to follow-up. Of the 64 remaining denied patients, 29 patients (45%) ultimately underwent MBS at a later date. These patients had long-term improvement in their hypertension (p<0.05), hyperlipidemia (p<0.05), diabetes (p<0.05), and pain (p<0.05). All 29 patients were alive at 12-year follow-up compared to the 35 patients who did not undergo MBS, of which 14 (40%) were deceased at 12-year follow-up (p<0.05). Interestingly, 13 of the remaining 21 living patients who did not undergo MBS are eligible today based on National Institutes of Health consensus criteria.


This study found that most patients who were initially turned away from MBS ultimately satisfied qualification criteria. Those who underwent MBS experienced long-term improvement in their co-morbid conditions and a survival advantage. However, denying patients who are seeking MBS is a death sentence for 40% of patients who, after initial denial, never underwent a metabolic operation.