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Bariatric Surgery

Physician-Supervised Diet and Exercise Program Sample

A sample diet and exercise program might entail the following:

A nutrition and exercise program must be supervised and monitored by a physician, working in cooperation with appropriately trained dietitians and/or nutritionists, for a total of six months (three consecutive) in the two years prior to surgery with physician notes that include the following:

  • Three- to six-month medically supervised weight loss including:
    • Dietitian consultation including a reduced-calorie diet
    • Increased physical activity documented in the medical record
    • Behavior modification

For patients who participate in a physician-supervised nutrition and exercise program, program records documenting the patient's participation and progress may substitute for physician medical records but these criteria must be met:

  • Dates for each visit must be documented (a physician summary letter will not suffice)
  • If a patient cannot exercise, the reason must be clearly documented in the medical record

Please note this is only an example. Insurance requirements are different for each insurance carrier.

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