Bariatric surgery, or weight loss surgery, is a significant intervention that can dramatically improve the health and quality of life for individuals struggling with severe obesity. However, it's not a decision to be taken lightly. This article will guide you through the qualifications for bariatric surgery, the preparation involved, different surgical options, and the postoperative care required, providing a comprehensive overview for those considering this life-changing procedure.
Determining Candidacy for Bariatric Surgery
When people ask if their weight alone qualifies them for bariatric surgery, there are a number of factors to consider when determining if bariatric surgery is the appropriate tool to help someone in their weight-loss journey.
Bariatric surgery requirements begin with establishing a diagnosis of class III obesity. Generally, bariatric surgery is considered for individuals who:
Have a BMI of 40 or higher. The Body Mass Index (BMI) is a way of estimating how much body fat you have based on your height-to-weight ratio. A score of 40 or higher is associated with a high risk of related diseases. For example, an adult who is 5’11” tall and weighs 290 lbs would have a BMI over 40. It usually equates to about 100 lbs. overweight.
Have a BMI of at least 35 and at least one related health problem. A BMI of 35 without a related health problem is considered class II obesity.
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The criteria are slightly higher for adolescents. An adolescent may be a candidate if they have:
- BMI of at least 40 and an obesity-related medical condition.
- BMI of at least 35 and a severe obesity-related medical condition.
While BMI is easily measured, you may have to take some medical tests to diagnose your obesity-related health conditions.
Additional Considerations
Beyond BMI, several other factors influence candidacy:
- Overall Health: You must be healthy enough to undergo surgery.
- Commitment to Lifestyle Changes: Even if you qualify for bariatric surgery based on the criteria above, you have to consider your goals and your ability to follow through. For example, it is important if you have a bariatric procedure that you make a lifelong commitment to making changes in your diet.
- Mental and Emotional Preparedness: Being “ready” means taking the time to think about if they’re emotionally prepared to navigate this big life change.
Debunking Common Myths About Bariatric Surgery
It's important to dispel some common misconceptions surrounding bariatric surgery:
- Myth: Surgery is a last resort. Bariatric surgery is the most effective long-term treatment for class III obesity. When studied scientifically, diet and exercise - alone or in combination with medications - are much less effective over the long term.
- Myth: Surgery is the “easy way out.” Bariatric surgery can be thought of as a tool that allows a healthy diet and lifestyle to lead to sustained weight loss. Often, patients have made these changes before without long-term success. Surgery allows those changes to be effective. Eating a healthy diet and being physically active always matters - even after surgery.
Preparing for Bariatric Surgery: A Comprehensive Evaluation
Before scheduling your bariatric surgery, your healthcare provider will want to ensure that you’re physically and mentally fit for the surgery. You’ll meet with a team of specialists who will counsel you about the risks and benefits while evaluating your physical and mental health. This multidisciplinary team of experts for follow-up care may include a nutritionist, an exercise physiologist or specialist, and a mental health professional.
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Medical Screening and Requirements
You may need to pass medical screening tests to make sure the surgery is safe for you. During the new patient visit, your surgeon will give you a list of tests needed for your evaluation. This usually includes blood tests, medical imaging and, in some cases, minor procedures such as an upper endoscopy to confirm you're a good candidate for surgery.
- Weight Limit: Ensure you weigh less than 450 pounds, the maximum weight that hospital radiology equipment can accommodate.
- Insurance Coverage: Verify that your health insurance plan will cover bariatric surgery at UCSF once certain requirements are met. Please notify us of any change in your insurance coverage, as it could impact your approval for surgery. Many insurance plans require three to six months of medically supervised weight-loss attempts before surgery. The UCSF Bariatric Surgery Center offers a Pathways to Weight Loss Clinic to help patients meet this requirement. We'll also review your insurance company's requirements for approving weight-loss surgery.
- Preventive Health: Ensure you're up to date with all your routine preventive health screenings.
- Lifestyle Modifications: If you use tobacco, drugs or excessive alcohol, you’ll be required to quit before qualifying for surgery. Your healthcare team can help you with this. If you use tobacco, you must stop at least six weeks before surgery to decrease your risk of postoperative complications.
Pre-Surgery Diet
Your surgeon may also ask you to follow a pre-bariatric surgery diet for a few weeks to prepare for your operation. This is to reduce the fat inside your abdomen, where the operation will take place, making the operation safer and reducing the risk of complications. Your surgeon will give you specific guidelines to follow.
Preoperative Visit
Once you've completed all necessary tests and met insurance requirements for surgery, you'll return to the Bariatric Surgery Center for your preoperative visit. During this appointment, your surgeon will discuss what to expect before, during and after surgery.
Types of Bariatric Surgery
Weight loss surgery is usually performed through minimally invasive methods (laparoscopic surgery). That means small incisions, faster healing and less pain and scarring than you would have with traditional open surgery. Several types of bariatric surgery are available, each with its own advantages and disadvantages:
Sleeve Gastrectomy
The gastrectomy simply removes a large portion of your stomach - about 80% - leaving behind a small, tubular portion, like a sleeve. This may be because it’s a relatively simple procedure that's safe to perform on most people with little risk of complications. This naturally reduces the amount of food you can consume in one sitting and makes you feel fuller faster. But it also reduces the hunger hormones that are normally produced in your stomach. This helps to stabilize your metabolism, decreasing your appetite and regulating your blood sugar.
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Gastric Bypass (Roux-en-Y)
The gastric bypass is also known as the “Roux-en-Y," which is a French term meaning “in the form of the letter Y.” With this procedure, your small intestine will end up in that form. First, surgeons create a small pouch at the top of your stomach, separating it from the lower portion with surgical staples. Then they divide your small intestine and bring the new segment up to connect to the stomach pouch. Food will now flow through the new, smaller stomach and lower segment of your small intestine, bypassing the rest. This restricts how much your stomach can hold and also how much nutrition your small intestine can absorb. Restricting the small intestine makes this method more effective than gastric restriction alone.
Biliopancreatic Diversion with Duodenal Switch (BPD-DS)
This is the original version of the duodenal switch, an operation that combines a sleeve gastrectomy with an intestinal bypass. (It sometimes goes by a shorter name: Gastric Reduction Duodenal Switch). It’s similar to the Roux-en-Y gastric bypass but more extreme. This operation bypasses most of your small intestine - about 75%. This significantly reduces the hunger hormones produced in your small intestine as well as in your stomach. It also significantly restricts how much nutrition your small intestine can absorb. This is what makes the duodenal switch the most effective surgery for weight loss and for improving metabolic syndromes like diabetes. But it can also make it hard for your body to absorb enough nutrients to stay healthy.
Stomach Intestinal Pylorus Sparing Surgery (SIPS)
This newer procedure is a modified version of the original duodenal switch, intended to reduce complications. It also goes by the names Loop Duodenal Switch or SADI-s. Early results are still being studied, but so far it appears promising that this version may eventually replace the original duodenal switch. Like the original, it begins with a sleeve gastrectomy, then divides the first part of the small intestine just after the stomach (the duodenum). This time, the small intestine is reattached as a loop, which requires just one surgical connection (anastomosis) instead of two. It also means that less of the small intestine is bypassed, allowing for a little more absorption of nutrients.
Postoperative Care and Expected Weight Loss
Follow-Up and Monitoring
During the first year after your surgery, your healthcare provider will see you regularly for follow-up visits and testing. They will take metabolic blood tests to monitor how your health is improving and screen for any nutritional deficiencies.
Body Contouring
After the first year, if you're in good health and have lost a lot of weight, you may want to discuss body contouring options with your healthcare provider. Body contouring can help remove excess skin folds and tighten loose tissues.
Expected Weight Loss
Most people - about 90% - lose about 50% of their excess weight after bariatric surgery, and keep it off. Different procedures have slightly different results. The average weight loss after gastric bypass is about 70% of excess body weight. After a duodenal switch, it’s about 80%. Weight loss after sleeve gastrectomy ranges between 30% and 80%.
Qualifications for Bariatric Surgeons and Facilities
The NIH, as well as the American College of Surgeons (ACS) and the American Society for Metabolic and Bariatric Surgery (ASMBS) also recommend that surgery be performed by a board certified surgeon with specialized experience/training in bariatric and metabolic surgery, and at a center that has a multidisciplinary team of experts for follow-up care. In addition, some insurance companies require that the surgery be performed at a facility that meets the ASMBS-approved quality standards (MBSAQIP).
American Board of Obesity Medicine (ABOM) Certification
While not explicitly mentioned in the provided text, certification by the American Board of Obesity Medicine (ABOM) is a significant qualification for physicians specializing in weight management. The steps to obtain ABOM certification typically involve:
- Step 1. Create an account in the ABOM application portal.
- Step 2. Locate documentation to support the minimum requirements of active, unrestricted medical license; active certification in an ABMS board; and residency completion in the US or Canada.
- Step 3. Determine how you will earn the required 60 CME credits. Remember: All 60 CME credits may come from GROUP ONE sources.
- Step 4. Step 5. Step 6.
- Proof of successful completion of an Obesity Medicine fellowship recognized by the Obesity Medicine Fellowship Council.
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