Bariatric Surgery: Are You a Candidate?
Weight loss surgery is considered only when all other options have been exhausted. Criteria for weight loss surgery include:
- 80 to 100 pounds overweight
- body mass index (BMI) greater or equal to 35, with one or more significant obesity-related conditions including high blood pressure, diabetes, arthritis, sleep apnea, and high cholesterol.
- BMI greater than 40, regardless of other medical conditions
- 16 to 70 years of age (with some exceptions)
- understands and accepts the operative risks
- history of multiple failed attempts with diet plans, behavioral, and medical therapy
- presence of realistic expectations and motivation
- capable of understanding the procedure and implications
- commitment to following the diet, vitamin supplementation, exercise program, and follow-up necessary for health and weight maintenance
These criteria are based on the National Institutes of Health Consensus Development Conference, March 25-27, 1991. Gastrointestinal Surgery for Severe Obesity. Published in the American Journal of Clinical Nutrition 1992:55:615s-9s.
Your Decision
The decision to undergo bariatric surgery is complex and intensely personal, with many factors to take into account. It should be made with the assistance of a bariatric physician and other members of the weight loss team. Each patient must consider the following:
Weight
Surgery is only offered when a patient is medically considered to be morbidly obese – that is, when they have a BMI of 40 or above, and/or are 80 to 100 or more pounds overweight -- or when they have a BMI of 35 or above and one or more obesity-related health problems. For patients who are not morbidly obese, the risk of surgery far outweighs the expected health benefits of the weight loss. Bariatric surgery is not performed for cosmetic reasons and in only rare, extenuating circumstances will bariatric surgery be considered for someone who does not meet the weight criteria.
Commitment to Lifestyle Change
For weight loss surgery to be successful, the patient must be willing to comply fully with the recommendations of the bariatric surgical team. This includes all recommended lifestyle changes (attitude, healthy eating and physical activity). Bariatric or weight loss surgery is only effective when used in combination with diet and exercise.
Other Medical Conditions
Diseases associated with morbid obesity often lead to significant and permanent damage to one or more organ systems. The most commonly affected organs are the lungs (sleep apnea), the heart (congestive failure or coronary artery disease), the kidneys (damage from diabetes or high blood pressure), and bones and joints (damage from stress and arthritis). Although medical problems increase the risk of any major surgical procedure including bariatric surgery, but they also strengthen the need for weight loss. Significant medical problems require careful consideration, but do not necessarily rule out the possibility of surgery.
Age
In general, surgery candidates are between the ages of 16 and 70, but there is a higher level of concern for those who are at the high and low ends of the age spectrum. Each patient is evaluated as to his or her ability to tolerate surgery, both physically and emotionally. Selected younger patients are sometimes candidates for a surgical approach to weight loss, depending on their history, medical problems, understanding of the procedure, family support, and other factors. Younger patients must demonstrate exceptional maturity and independent thought to be good candidates for a bariatric surgical procedure.