A survey conducted by the Obesity and Metabolic Surgery Society of India (OSSI), a not-for-profit body of bariatric and metabolic surgeons, has revealed significant insurance-related hurdles that are preventing timely and life-saving care for patients 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 shows implementation remains inconsistent, creating barriers that delay treatment, worsen complications, and increase long-term healthcare costs.
The study titled ‘The Surgeons’ Perspective On Insurance Coverage For Metabolic and Bariatric Surgery For India’ is published in Obesity Surgery: The Journal Of Metabolic Surgery And Allied Care.
Rising obesity burden
India’s obesity prevalence is projected to triple by 2040. Doctors stress that obesity is not a lifestyle flaw, but a chronic, progressive condition linked to type 2 diabetes, hypertension, sleep apnoea, heart disease, infertility, and certain cancers. Bariatric and metabolic surgery, which can reduce body weight by 30 to 40% and reverse many associated illnesses, is among the most effective treatments. Yet, limited insurance support leaves many patients untreated or waiting for months.
Survey findings
The OSSI survey, conducted among 109 bariatric surgeons across multiple states between November 2024 and March 2025, paints a stark picture. 95.4% of surgeons reported patients delaying surgery while awaiting insurance approval. Most surgeons (76.1%) said patients are unaware that insurance covers bariatric surgery even when medical criteria are met. The approval process was rated complex by 69.7%, and 91.7% said it is more cumbersome than other routine surgeries. Nearly one-third reported denial rates of 50 to 75%, citing obesity exclusions, waiting periods, and documentation discrepancies. 81.7% noted significant out-of-pocket costs despite insurance.
Eligibility gaps
Surgeons strongly supported lowering BMI thresholds and covering more comorbidities than currently listed under IRDAI rules. While OSSI guidelines recommend surgery for patients with BMI ≥35 kg/m² or >30 kg/m² with comorbidities, IRDAI restricts coverage to BMI ≥40 kg/m² or ≥35 kg/m² only with severe comorbidities.
“Obesity is not a cosmetic issue; it is a chronic, progressive, and often disabling disease that affects every organ of the body,” Dr. Sumeet Shah, Secretary of OSSI, said.
Dr. Randeep Wadhawan, president of OSSI, added that 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. 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,” he said.
Impact on patients
Delays have serious consequences, Dr. Manish Khaitan, former OSSI president, said. “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.”
Dr. Aparna Govil Bhasker emphasized the gap between policy and reality and said that 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,” she said.
Dr. Surendra Ugale from Hyderabad urged insurers to act with clarity and compassion, “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.”
Despite medical progress and IRDAI guidelines, the lack of smooth and consistent coverage remains a major obstacle. “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,” Dr. Wadhawan said.
Published – November 26, 2025 07:03 pm IST
