Qualifying for Bariatric Surgery

Bariatric surgery technique has been refined over the past several decades, as have the guidelines for qualification for surgery. This experience has yielded generally accepted policies to determine patients who will benefit from a bariatric surgical procedure. Some of these considerations include:

A BMI of greater than 35 – New guidelines from ASMBS & IFSO have set this as the threshold for having bariatric surgery, but most insurance plans cover surgery for patients with a BMI over 40.

A BMI of between 30 and 35 where the patient also suffers from any of the following diseases associated with their weight:

• Type 2, or adult-onset, diabetes.
• Symptomatic atherosclerotic heart disease – where the arteries have been partially occluded by plaque.
• Uncontrolled or poorly controlled high blood pressure and/or high cholesterol.
• Sleep apnea requiring a CPAP device.

While acid reflux or GERD, polycystic ovarian syndrome (PCOS), and osteoarthritis are all potentially caused or worsened by obesity, these may not be considered comorbidities that would qualify a patient for surgery if they have a BMI under 35-40.

Some patients will also require a medically supervised weight loss program. During this time, patients will be guided through a long-term diet and exercise regimen. Patients with extremely high BMI or at significant risk due to their obesity-related comorbidities may have a shorter preoperative non-surgical weight loss program due to the urgency of their conditions.

Of course, bariatric surgery has a psychological component, and the patient must understand the consequences of their decision early in the process. This may require a referral to a mental health professional.

Lastly, patients will undergo testing to help ensure their suitability for surgery. These preoperative tests are essential in understanding whether the heart, lungs, and other organs can withstand the stresses of anesthesia and surgery.

You will often hear that bariatric surgery is not a magic bullet or the easy way out. And this is true. Surgery is just the beginning of a lifelong journey to eliminate weight and maintain a new, better level of health. To succeed, patients will require much dedication and focus on their continued weight loss and lifestyle changes.