Discover If You Qualify for Weight Loss Surgery: Is Bariatric Surgery Your Ultimate Solution?

Obesity is a growing concern in the United States, affecting a significant portion of the adult and youth populations. It is associated with numerous health complications, including type 2 diabetes, heart disease, stroke, and certain types of cancer. Weight-loss surgery, also known as bariatric surgery, can be a life-changing option for individuals struggling with obesity and related medical conditions. This article will explore the qualifications for weight loss surgery, the evaluation process, and the importance of a comprehensive treatment plan.

Understanding Weight-Loss Surgery

Weight-loss surgery changes the shape and function of your digestive system. It is designed to help individuals lose weight and manage medical conditions related to obesity. These surgical procedures limit how much food you can eat, leading to weight loss. However, it's crucial to understand that weight-loss surgery is just one component of a comprehensive treatment plan that includes nutrition guidelines, exercise, and mental health care.

General Medical Guidelines and BMI

The general medical guidelines for weight-loss surgery are based on body mass index (BMI). BMI is a formula that uses weight and height to estimate body fat. While BMI is easily measured, you may have to take some medical tests to diagnose your obesity-related health conditions.

BMI of 40 or higher: Individuals with a BMI of 40 or higher, which typically equates to being more than 100 pounds overweight, may qualify for weight-loss surgery. A score of 40 or higher is associated with a high risk of related diseases.
BMI of 35 or higher with obesity-related conditions: People with a BMI of at least 35 and at least one related health problem may also be eligible. A BMI of 35 without a related health problem is considered class II obesity. Certain conditions, such as diabetes and heart disease, are often more difficult to fight when you are carrying a lot of extra weight. If you have one or more health conditions in addition to being overweight, you may qualify for weight loss surgery. Learn more about the obesity-associated conditions we treat.

In some cases, weight-loss surgery may be an option for adolescents. Instead of using these BMI numbers as a guideline for surgery, a surgeon may use growth charts for adolescents. These charts show the standard BMI range for each age. 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.

Additional Qualifications and Considerations

Beyond BMI, several other factors can influence your eligibility for weight-loss surgery:

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Age: Bariatric surgery is generally considered safe for adults ages 18 to 65. If you are younger than 18 or older than 65, there is a higher risk of surgical complications.
Weight Limit: Weigh less than 450 pounds, the maximum weight that hospital radiology equipment can accommodate.
Health History: Your health history includes obesity-associated conditions.
Lifestyle: You live a healthy lifestyle or are willing to adjust your lifestyle.
Tobacco Use: If you use tobacco, you must stop at least six weeks before surgery to decrease your risk of postoperative complications. Refraining from tobacco is also part of living a healthy lifestyle.
Previous Weight Loss Attempts: Have you previously attempted to lose weight without bariatric surgery? If you have not been able to lose weight on your own, your insurance may require you to try one more time with a physician’s help.
Commitment to Lifestyle Changes: How committed are you to adopting a healthier lifestyle? To qualify for weight loss surgery, you must demonstrate a commitment toward a healthy lifestyle. This commitment includes working to change your eating and exercise habits. We help you set realistic goals. Making steady progress toward these goals can help you qualify for surgery.
Motivation: Are you motivated to embrace lifestyle changes, set goals and educate yourself about healthy nutrition?
Weight-Loss History: What dieting and exercise plans have you used in the past to lose weight? Did you lose weight or regain weight?
Eating Behaviors: Irregular eating behaviors or eating disorders may contribute to obesity. These include binge eating, nighttime eating and unplanned grazing between meals.
Mood Disorders: Depression, anxiety, bipolar disorder or other mood disorders are associated with obesity, and these conditions may make it difficult to manage your weight.
Alcohol and Drug Use: Problems with alcohol or drug use, as well as smoking, are associated with poor weight loss and continued substance use problems after surgery. Addiction to alcohol and drugs must be addressed.
Suicide Risk: There is an increased risk of suicide among people who have undergone weight-loss surgery.
Participant Responsibility: There is a demonstration of participant responsibility.
Language Proficiency: When there is an obvious disconnect in the communication process between the practitioner and patient due to the patient’s lack of proficiency in the English language, an interpreter is required.
Glycemic Control: Optimization of glycemic control.
Dyslipidemia: Treatment of dyslipidemia.
Estrogen Therapy: Discontinuing estrogen therapy, if applicable.
Cardiology Consultation: Cardiology consultation and beta-adrenergic blockade, if indicated.
Preoperative Weight Loss: Preoperative weight loss should be considered in patients whom reduction of liver volume is expected to improve the technical aspects of surgery.

People with active alcohol use disorder, drug addictions, or major psychiatric disorders may not qualify for weight loss surgery. You also need to be healthy enough to have general anesthesia during surgery.

The Evaluation Process

The process the team uses to determine if you're ready for weight-loss surgery is also there to help you make an informed decision. If you meet the criteria for weight loss surgery, you’ll begin a series of evaluations and tests with our bariatric medicine team. Members of your team will explain what to expect before and after the procedure. They will evaluate whether you're ready for surgery and help you decide if it's an option for you. You'll have a medical exam to diagnose any unknown obesity-related conditions. Your doctor also will test for problems that could make surgery more complicated.

Initial Consultation: During the new patient visit, your surgeon will give you a list of tests needed for your evaluation.
Medical and Psychological Assessments: You’ll meet with a team of specialists who will counsel you about the risks and benefits while evaluating your physical and mental health.
Medical Screening Tests: You may need to pass medical screening tests to make sure the surgery is safe for you.
Blood Tests, Medical Imaging, and Minor Procedures: 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.
Nutritional Assessment and Counseling: Documentation of nutritional assessment and counseling at each visit with at least one visit with a registered dietitian or nutritionist. Dietary history, eating disorder, pre-surgical caloric reduction, dietary behavior modification, and lifelong need for dietary changes must be completed.
Psychosocial-Behavioral Evaluation: Psychosocial-behavioral evaluation must be completed within 12 months of prior approval request by a licensed psychologist, psychiatrist, clinical social worker, and/or advanced practice nurse in collaboration with co-signing psychiatrist.
Education: Education regarding risks and benefits of bariatric surgery and procedural options.
Pulmonary Evaluation: Pulmonary evaluation, including arterial blood gas measurement and polysomnography, if indicated.
Diagnostic Evaluation for Deep Venous Thrombosis: Diagnostic evaluation for deep venous thrombosis and vena cava filter, if indicated.
Abdominal Ultrasonography and Viral Hepatitis Screen: Abdominal ultrasonography and viral hepatitis screen.
CPAP or BiPAP: Institution of CPAP or BiPAP as indicated for obstructive sleep apnea (OSA), obesity-hypoventilation syndrome (OHS), or Pickwickian syndrome.
Coronary Artery Disease: Coronary artery disease documented by stress testing, previous need for angioplasty, or coronary bypass.
Peripheral Arterial Disease: Peripheral arterial disease documented by arteriography or Doppler ultrasound of brachial and ankle pressures before and after exercise.
Cardiomyopathy: Cardiomyopathy documented by echocardiogram or MRI.
Pulmonary Hypertension: Pulmonary hypertension by echocardiogram.
Carotid Artery Disease: Carotid artery disease documented by ultrasound with greater than 70% blockage at least unilaterally.
Aortic Disease: Aortic disease documented by CT or MRI.
Severe Valvular Disease: Severe valvular disease documented by echocardiogram.
Medically Refractory Hypertension: Medically refractory hypertension defined as a systolic pressure greater than or equal to 140 and/or a diastolic greater than or equal to 90 obtained by appropriately sized cuff despite treatment with at least 2 antihypertensive medications at maximum tolerable dosages.
Nonalcoholic Fatty Liver Disease (NAFLD) / Nonalcoholic Steatohepatitis (NASH): Nonalcoholic fatty liver disease (NAFLD) / nonalcoholic steatohepatitis (NASH) with submission of liver function panel.
Dyslipidemia: Dyslipidemia as defined by hypercholesterolemia greater than 240 mg/dl, hypertriglyceridemia greater than 400 mg/dl, low density lipoprotein greater than 160 mg/dl, or high density lipoprotein less than 40 mg/dl despite therapy with at least one lipid lowering agent at maximum dosage.
Pseudotumor Cerebri: Pseudotumor cerebri.
Gastroesophageal Reflux (GERD): Gastroesophageal reflux (GERD).
Asthma: Asthma with severity at least of mild persistent.
Lower Extremity Venous/Lymphatic Obstructive Stasis Disease: Lower extremity venous/lymphatic obstructive stasis disease.
Severe Urinary Incontinence: Severe urinary incontinence.
Degenerative Osteoarthritis: Degenerative osteoarthritis documented radiographically in any weight bearing joint or lumbosacral spine affecting performance of activities of daily living.
Uncontrolled Type 2 Diabetes Mellitus: Uncontrolled type 2 diabetes mellitus.
Metabolic Syndrome: Metabolic syndrome.
Commitment from Parent or Guardian (for Adolescents): Inclusion of a statement detailing at least one custodial parent or legal guardian’s commitment to support and facilitate the adolescent patient’s loss of weight, willingness to support, and facilitate permanent life style changes.

If your team members recommend bariatric surgery, they will work with you to develop a treatment plan.

Insurance Coverage

Your insurance company may cover the costs of weight-loss surgery. Check if your insurance cover include weight loss surgery. Some insurance plans cover weight loss surgery while others do not. If you do have coverage, you may be limited to certain procedures. You may also need to meet several requirements, such as undergoing a psychological screening, before your surgery is approved. It's important to research your insurance coverage and your expected out-of-pocket costs.

Insurance Requirements: We'll also review your insurance company's requirements for approving weight-loss 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.
Medical Necessity: Your team will need to show that the procedure is medically necessary.
Documented Evidence: Also, you may need to provide documented evidence that you weren't able to lose enough weight with a supervised program of diet and exercise.
Notify Changes: Please notify us of any change in your insurance coverage, as it could impact your approval for surgery.

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. 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.

Components of a Comprehensive Treatment Plan

Weight loss after surgery depends on your ability to change behaviors in eating and exercise. Also, being in good mental health is important for the demands of following your treatment plan. If your team members recommend bariatric surgery, they will work with you to develop a treatment plan.

Nutrition Guidelines: The dietitian will help you with nutrition guidelines, vitamin supplements and menu planning.
Exercise Plan: Weight loss.
Psychotherapy: You may be required to begin talk therapy, drug treatment or other mental health therapy to treat an eating disorder, depression or other mental health condition.
Smoking: Other treatments.

These requirements are intended to help you achieve the best possible weight-loss outcomes after surgery. Also, your ability to follow through on these plans will show your team how motivated you are to follow guidelines after surgery.

Bariatric Surgery Procedures

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.

Sleeve Gastrectomy: The gastrectomy simply removes a large portion of your stomach - about 80% - leaving behind a small, tubular portion, like a sleeve. 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. Weight loss after sleeve gastrectomy ranges between 30% and 80%.
Gastric Bypass (Roux-en-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. The average weight loss after gastric bypass is about 70% of excess body weight.
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’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. After a duodenal switch, it’s about 80%.
Stomach Intestinal Pylorus Sparing Surgery (SIPS): This newer procedure is a modified version of the original duodenal switch, intended to reduce complications. 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

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. 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.

Most people - about 90% - lose about 50% of their excess weight after bariatric surgery, and keep it off.

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