The OSSI survey revealed that 87.2% of surgeons saw higher patient interest after the 2019 IRDAI mandate for inclusion of bariatric and metabolic surgery. However, most surgeons reported under-utilization of insurance coverage due to low awareness, high out of pocket costs, and complex paperwork. A striking 95.4% of surgeons said patients delay surgery while waiting for approval, and 69.7% rated the entire insurance approval process as complicated

Mumbai: A new national survey conducted by the Obesity and Metabolic Surgery Society of India (OSSI) has revealed significant insurance related hurdles that are preventing timely and life-saving care for patient living with severe obesity. Led by Dr. Aparna Govil Bhasker, Bariatric and Metabolic Surgeon at Saifee Hospital, Mumbai, along with senior surgeons from across the country, the research highlights critical gaps in access to care. The Insurance Regulatory and Development Authority of India (IRDAI) mandated coverage for metabolic and bariatric surgery in 2019 when medical criteria are met. However, the survey reveals that implementation remains inconsistent. These gaps in execution create multiple barriers for patients — delaying treatment, increasing complications, worsening long-term health outcomes. This has a major adverse impact on long term health care costs related to chronic disease management.

The Obesity and Metabolic Surgery Society of India (OSSI) represents bariatric and metabolic surgeons nationwide and is committed to advancing safe, evidence-based, and accessible care for obesity and metabolic diseases. “Those recommended for metabolic surgery should proceed without delay, as postponing treatment only worsens obesity-related diseases. Early treatment supports faster recovery, better health outcomes”, said Dr. Randeep Wadhawan- President of OSSI.

The Surgeons’ Perspective On Insurance Coverage For Metabolic and Bariatric Surgery For India: An Obesity and Metabolic Surgery Society of India (OSSI) is published in Obesity Surgery:

India is witnessing an alarming rise in obesity and the overall prevalence is set to triple in numbers by the year 2040. Obesity affects millions of people from younger to older age groups. Doctors stress that it is not a lifestyle flaw but a complex, chronic, progressive and relapsing medical condition that leads to type 2 diabetes, hypertension, sleep apnea, heart disease, joint problems, infertility, and increases the risk of certain cancers. Bariatric and metabolic surgery is one of the most effective treatment options for severe obesity that can lead to total body weight loss of 30 to 40% and reverse many of the associated illnesses. It can help patients regain health, mobility, and improve their quality of life. However, limited insurance support continues to leave many patients untreated or delays their care for months or years.

To understand the insurance gaps that continue to hinder access to life-saving bariatric and metabolic surgery in India, a cross-sectional survey was conducted using a structured questionnaire among 109 bariatric surgeons from multiple states between November 2024 and March 2025. The questions focused on surgeon demographics, insurance challenges, patient behaviour, approval delays, denial reasons, and suggestions for policy improvement. All data were collected anonymously and analyzed using descriptive statistics.

Key findings from the OSSI survey revealed that 95.4% of surgeons report patients delaying bariatric and metabolic surgery while awaiting insurance approval. Most surgeons (76.1%) said patients are unaware that insurance covers bariatric surgery even when medical criteria are met, and actual utilization remains low. The approval process was largely viewed as difficult, with 69.7% rating it complex and 91.7% stating it is more cumbersome than approvals for other routine surgeries. High denial rates were noted, with nearly one-third of the surgeons reporting 50–75% rejections. Common reasons for rejection were- obesity exclusions, waiting period issues, or documentation discrepancies. 81.7% of surgeons reported significant out-of-pocket costs despite insurance.

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There was strong agreement on expanding eligibility—most supported lowering BMI thresholds and covering more comorbidities than presently listed in the IRDA mandate, and 94.5% felt metabolic surgery should be covered for type 2 diabetes. Nearly all surgeons (99.1%) agreed that insurance processes need major streamlining to improve access to care. They stressed on the need for urgent reform to simplify processes, expand criteria, and improve the speed of approvals.

“Obesity is not a cosmetic issue; it is a chronic, progressive, and often disabling disease that affects every organ of the body”, said Dr. Sumeet Shah- Secretary OSSI.

“The OSSI Guidelines clearly state that bariatric, obesity, or weight-loss surgery should be considered for eligible Indian patients with a BMI ≥ 35 kg/m² with or without associated diseases, and for patients with a BMI > 30 kg/m² when significant comorbidities are present,” said Dr. Randeep Wadhawan, President, OSSI. “However, the current IRDAI insurance approval criteria still restrict coverage to patients with BMI ≥ 40 kg/m², or ≥ 35 kg/m² only when severe comorbidities are documented. This creates a major gap between evidence-based medical guidelines and the insurance eligibility framework, ultimately limiting access for patients who would benefit most from early surgical intervention.”

“When patients cannot undergo bariatric surgery on time because of insurance delays, their disease continues to progress. Months are lost waiting for approvals, and during this period their metabolic, hormonal, and cardiovascular health often worsens. Bariatric and metabolic surgery is not cosmetic—it is a scientifically proven, disease-modifying treatment that prevents long-term complications. Insurance coverage is not a privilege; it is a medical necessity that saves lives,” said Dr. Manish Khaitan, past President of OSSI.

Dr. Aparna Govil Bhasker further added, “The survey shows that even after IRDAI’s mandate, the gap between policy and reality is very wide. Patients face confusion, endless paperwork, repeated queries, and high out-of-pocket expenses. As surgeons, we strongly appeal to insurance providers to understand that obesity is a medical disease and that treatment should be easily accessible. Simplifying the process and widening eligibility criteria will help thousands of individuals who are fighting serious weight-related illnesses.”

“The policymakers and insurance companies should bring more clarity, transparency, and compassion into the approval system. Lowering BMI thresholds in accordance with OSSI guidelines, including obesity-related conditions like type 2 diabetes, and reducing unnecessary documentation can make a huge difference. Early access to bariatric and metabolic surgery not only improves patient health but also reduces long-term healthcare costs for families and insurers”, said Dr. Surendra Ugale, a senior bariatric and metabolic surgeon from Hyderabad.

“When people get timely treatment, they can return to work, support their families, and lead healthier, happier lives. We hope this study will encourage urgent and positive action to improve coverage for obesity treatment,” underscored Dr. Aparna Govil Bhasker.

"Despite medical progress and IRDAI guidelines, the lack of smooth and consistent insurance coverage for bariatric and metabolic surgery continues to be one of the biggest obstacles for Indian patients living with obesity. Addressing these gaps through simpler approvals, wider eligibility, and stronger awareness can improve access to life-saving treatment and strengthen India’s public health landscape," said Dr. Randeep Wadhawan.